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Photoprotection in skin of color

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Abstract

As populations in many parts of the world are projected to become more racially diverse over the coming decades, we must better understand the unique characteristics of the skin of populations with skin of color (SOC). This review aims to highlight important physiologic and clinical considerations of photoprotection in SOC. Ultraviolet radiation and visible light affect dark and light skin differently. SOC populations have historically not been informed on photoprotection to the same degree as their light skinned counterparts. This has exacerbated dermatologic conditions in which SOC populations are disproportionately affected, such as hyperpigmentary disorders. Patients should be encouraged to utilize multiple methods of photoprotection, ranging from avoidance of sunlight during peak intensity hours, seeking shade, wearing sun-protective clothing and wide-brimmed hat, and applying sunscreen. Ideal sunscreens for SOC populations include those with UVA-PF/SPF ratios ≥ 2/3 and tinted sunscreens to protect against VL. Although there have been increased efforts recently, more research into photoprotection for SOC and targeted public education are required to disseminate photoprotection resources that are patient-centered and evidence-based.

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Abbreviations

FST:

Fitzpatrick skin typing

ITA:

Individual typology angle

MED:

Minimal erythema dose

MMP:

Matrix metalloproteinase

PIH:

Post-inflammatory hyperpigmentation

ROS:

Reactive oxygen species

SOC:

Skin of color

SPF:

Sun-protection factor

SPT:

Skin phototypes

UPF:

Ultraviolet protective factor

UV:

Ultraviolet

UVR:

Ultraviolet radiation

VL:

Visible light

References

  1. Heath, C. R., DeLeo, V. A., & Taylor, S. C. (2021). Increasing skin of color publications in the dermatology literature: A call to action. Cutis, 108(3), 155–157.

    Article  PubMed  Google Scholar 

  2. Kimball, A. B. (2008). Skin differences, needs, and disorders across global populations. Journal of Investigative Dermatology Symposium Proceedings, 13(1), 2–5.

    Article  PubMed  Google Scholar 

  3. Brenner, M., & Hearing, V. J. (2008). The protective role of melanin against UV damage in human skin. Photochemistry and Photobiology, 84(3), 539–549.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kumar, P., & Kim, N. (2021). Age-based gaps between awareness of photoaging and photoprotective practices among African American adults. Photodermatology, Photoimmunology & Photomedicine, 37, 428–430.

    Article  Google Scholar 

  5. Taylor, S. C., Alexis, A. F., Armstrong, A. W., Fuxench, Z. C. C., & Lim, H. W. (2022). Misconceptions of photoprotection in skin of color. Journal of the American Academy of Dermatology, 86(3), S9–S17.

    Article  PubMed  Google Scholar 

  6. Colby, S. L., & Ortman, J. M. (2015). Projections of the size and composition of the US Population: 2014 to 2060. Population estimates and projections. Current Population Reports. P25-1143. US Census Bureau.

  7. Rees, P., Wohland, P., Norman, P., & Boden, P. (2012). Ethnic population projections for the UK, 2001–2051. Journal of Population Research, 29(1), 45–89.

    Article  Google Scholar 

  8. Taylor, S. C. (2002). Skin of color: Biology, structure, function, and implications for dermatologic disease. Journal of the American Academy of Dermatology, 46(2), S41–S62.

    Article  PubMed  Google Scholar 

  9. Kundu, R. V., & Patterson, S. (2013). Dermatologic conditions in skin of color: Part I. Special considerations for common skin disorders. American Family Physician, 87(12), 850–856.

    PubMed  Google Scholar 

  10. Osto, M., Hamzavi, I. H., Lim, H. W., & Kohli, I. (2022). Individual typology angle and fitzpatrick skin phototypes are not equivalent in photodermatology. Photochemistry and Photobiology, 98(1), 127–129.

    Article  CAS  PubMed  Google Scholar 

  11. Ware, O. R., Dawson, J. E., Shinohara, M. M., & Taylor, S. C. (2020). Racial limitations of Fitzpatrick skin type. Cutis, 105(2), 77–80.

    PubMed  Google Scholar 

  12. Onalaja, A. A., & Taylor, S. C. (2021). Defining skin of color. In B. S. Li & H. I. Maibach (Eds.), Ethnic skin and hair and other cultural considerations (pp. 3–18). Springer.

    Chapter  Google Scholar 

  13. Sommers, M. S., Fargo, J. D., Regueira, Y., Brown, K. M., Beacham, B. L., Perfetti, A. R., Everett, J. S., & Margolis, D. J. (2019). Are the Fitzpatrick skin phototypes valid for cancer risk assessment in a racially and ethnically diverse sample of women? Ethnicity & Disease, 29(3), 505.

    Article  Google Scholar 

  14. Agbai, O. N., Buster, K., Sanchez, M., Hernandez, C., Kundu, R. V., Chiu, M., Roberts, W. E., Draelos, Z. D., Bhushan, R., Taylor, S. C., & Lim, H. W. (2014). Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. Journal of the American Academy of Dermatology, 70(4), 748–762.

    Article  PubMed  Google Scholar 

  15. Wilkes, M., Wright, C. Y., du Plessis, J. L., & Reeder, A. (2015). Fitzpatrick skin type, individual typology angle, and melanin index in an African population: Steps toward universally applicable skin photosensitivity assessments. JAMA Dermatology, 151(8), 902–903.

    Article  PubMed  Google Scholar 

  16. Eilers, S., Bach, D. Q., Gaber, R., Blatt, H., Guevara, Y., Nitsche, K., Kundu, R. V., & Robinson, J. K. (2013). Accuracy of self-report in assessing Fitzpatrick skin phototypes I through VI. JAMA Dermatology, 149(11), 1289–1294.

    Article  PubMed  Google Scholar 

  17. Karsten, A. E., Singh, A., Karsten, P. A., & Braun, M. W. (2013). Diffuse reflectance spectroscopy as a tool to measure the absorption coefficient in skin: South African skin phototypes. Photochemistry and Photobiology, 89(1), 227–233.

    Article  CAS  PubMed  Google Scholar 

  18. D’Orazio, J., Jarrett, S., Amaro-Ortiz, A., & Scott, T. (2013). UV radiation and the skin. International Journal of Molecular Sciences, 14(6), 12222–12248.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Austin, E., Geisler, A. N., Nguyen, J., Kohli, I., Hamzavi, I., Lim, H. W., & Jagdeo, J. (2021). Visible light. Part I: Properties and cutaneous effects of visible light. Journal of the American Academy of Dermatology, 84(5), 1219–1231.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Clydesdale, G. J., Dandie, G. W., & Muller, H. K. (2001). Ultraviolet light induced injury: Immunological and inflammatory effects. Immunology and Cell Biology, 79(6), 547–568.

    Article  CAS  PubMed  Google Scholar 

  21. Sklar, L. R., Almutawa, F., Lim, H. W., & Hamzavi, I. (2012). Effects of ultraviolet radiation, visible light, and infrared radiation on erythema and pigmentation: A review. Photochemical & Photobiological Sciences, 12(1), 54–64.

    Article  Google Scholar 

  22. Kohli, I., Chaowattanapanit, S., Mohammad, T. F., Nicholson, C. L., Fatima, S., Jacobsen, G., Kollias, N., Lim, H. W., & Hamzavi, I. H. (2018). Synergistic effects of long-wavelength ultraviolet Al and visible light on pigmentation and erythema. British Journal of Dermatology, 178(5), 1173–1180.

    Article  CAS  PubMed  Google Scholar 

  23. Kaidbey, K. H., Agin, P. P., Sayre, R. M., & Kligman, A. M. (1979). Photoprotection by melanin—A comparison of black and Caucasian skin. Journal of the American Academy of Dermatology, 1(3), 249–260.

    Article  CAS  PubMed  Google Scholar 

  24. Cragg, N., Chadwick, C. A., Potten, C. S., Sheehan, J. M., & Young, A. R. (2002). Repeated ultraviolet exposure affords the same protection against DNA photodamage and erythema in human skin types II and IV but is associated with faster DNA repair in skin type IV. Journal of Investigative Dermatology, 118(5), 825–829.

    Article  PubMed  Google Scholar 

  25. Jimbow, K., Quevedo, W. C., Jr., Fitzpatrick, T. B., & Szabo, G. (1976). Some aspects of melanin biology: 1950–1975. Journal of Investigative Dermatology, 67(1), 72–89.

    Article  CAS  PubMed  Google Scholar 

  26. Bradford, P. T. (2009). Skin cancer in skin of color. Dermatology nursing/Dermatology Nurses’ Association, 21(4), 170.

    PubMed Central  Google Scholar 

  27. Fisher, G. J., Kang, S., Varani, J., Bata-Csorgo, Z., Wan, Y., Datta, S., & Voorhees, J. J. (2002). Mechanisms of photoaging and chronological skin aging. Archives of Dermatology, 138(11), 1462–1470.

    Article  CAS  PubMed  Google Scholar 

  28. Szabó, G., Gerald, A. B., Pathak, M. A., & Fitzpatrick, T. B. (1969). Racial differences in the fate of melanosomes in human epidermis. Nature, 222(5198), 1081–1082.

    Article  PubMed  Google Scholar 

  29. Tadokoro, T., Kobayashi, N., Zmudzka, B. Z., Ito, S., Wakamatsu, K., Yamaguchi, Y., Korossy, K. S., Miller, S. A., Beer, J. Z., & Hearing, V. J. (2003). UV-induced DNA damage and melanin content in human skin differing in racial/ethnic origin. The FASEB Journal, 17(9), 1177–1179.

    Article  CAS  PubMed  Google Scholar 

  30. Del Bino, S., Sok, J., Bessac, E., & Bernerd, F. (2006). Relationship between skin response to ultraviolet exposure and skin color type. Pigment Cell Research, 19(6), 606–614.

    Article  PubMed  Google Scholar 

  31. Halder, R. M., & Bridgeman-Shah, S. (1995). Skin cancer in African Americans. Cancer, 75(S2), 667–673.

    Article  CAS  PubMed  Google Scholar 

  32. Han, A., Chien, A. L., & Kang, S. (2014). Photoaging. Dermatologic Clinics, 32(3), 291–299.

    Article  CAS  PubMed  Google Scholar 

  33. Taylor, S. C. (2005). Photoaging and pigmentary changes of the skin. In C. M. Burgess (Ed.), Cosmetic dermatology (pp. 29–51). Springer.

    Chapter  Google Scholar 

  34. Iwuala, C., & Taylor, S. C. (2022). Structural and functional differences in skin of colour. Clinical and Experimental Dermatology, 47(2), 247–250.

    Article  CAS  PubMed  Google Scholar 

  35. Badreshia-Bansal, S., Patel, M., & Taylor, S. C. (2016). Structure and function of skin. In A. Kelly, S. C. Taylor, H. W. Lim, & A. Serrano (Eds.), Taylor and Kelly’s dermatology for skin of color, 2e. McGraw Hill.

    Google Scholar 

  36. Fisher, G. J., Wang, Z., Datta, S. C., Varani, J., Kang, S., & Voorhees, J. J. (1997). Pathophysiology of premature skin aging induced by ultraviolet light. New England Journal of Medicine, 337(20), 1419–1429.

    Article  CAS  PubMed  Google Scholar 

  37. Griffiths, C. E., Wang, T. S., Hamilton, T. A., Voorhees, J. J., & Ellis, C. N. (1992). A photonumeric scale for the assessment of cutaneous photodamage. Archives of Dermatology, 128(3), 347–351.

    Article  CAS  PubMed  Google Scholar 

  38. Larnier, C., Ortonne, J. P., Venot, A., Faivre, B., Béani, J. C., Thomas, P., Brown, T. C., & Sendagorta, E. (1994). Evaluation of cutaneous photodamage using a photographic scale. British Journal of Dermatology, 130(2), 167–173.

    Article  CAS  PubMed  Google Scholar 

  39. Chung, J. H., Lee, S. H., Youn, C. S., Park, B. J., Kim, K. H., Park, K. C., Cho, K. H., & Eun, H. C. (2001). Cutaneous photodamage in Koreans: Influence of sex, sun exposure, smoking, and skin color. Archives of Dermatology, 137(8), 1043–1051.

    CAS  PubMed  Google Scholar 

  40. Chien, A. L., Qi, J., Grandhi, R., Kim, N., César, S. S., Harris-Tryon, T., Jang, M. S., Olowoyeye, O., Kuhn, D., Leung, S., & Rainer, B. M. (2018). Effect of age, gender, and sun exposure on ethnic skin photoaging: Evidence gathered using a new photonumeric scale. Journal of the National Medical Association, 110(2), 176–181.

    Article  PubMed  Google Scholar 

  41. Stern, R. S. (2010). Prevalence of a history of skin cancer in 2007: Results of an incidence-based model. Archives of Dermatology, 146(3), 279–282.

    Article  PubMed  Google Scholar 

  42. Dennis, L. K., Vanbeek, M. J., Freeman, L. E. B., Smith, B. J., Dawson, D. V., & Coughlin, J. A. (2008). Sunburns and risk of cutaneous melanoma: Does age matter? A comprehensive meta-analysis. Annals of Epidemiology, 18(8), 614–627.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wu, S., Han, J., Laden, F., & Qureshi, A. A. (2014). Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: A cohort study. Cancer Epidemiology, Biomarkers & Prevention, 23(6), 1080–1089.

    Article  Google Scholar 

  44. An, S., Kim, K., Moon, S., Ko, K. P., Kim, I., Lee, J. E., & Park, S. K. (2021). Indoor tanning and the risk of overall and early-onset melanoma and non-melanoma skin cancer: Systematic review and meta-analysis. Cancers, 13(23), 5940.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Colantonio, S., Bracken, M. B., & Beecker, J. (2014). The association of indoor tanning and melanoma in adults: Systematic review and meta-analysis. Journal of the American Academy of Dermatology, 70(5), 847–857.

    Article  PubMed  Google Scholar 

  46. Lopes, F. C., Sleiman, M. G., Sebastian, K., Bogucka, R., Jacobs, E. A., & Adamson, A. S. (2021). UV exposure and the risk of cutaneous melanoma in skin of color: A systematic review. JAMA Dermatology, 157(2), 213–219.

    Article  PubMed  Google Scholar 

  47. Kolitz, E., Lopes, F. C., Arffa, M., Pineider, J., Bogucka, R., & Adamson, A. S. (2022). UV Exposure and the risk of keratinocyte carcinoma in skin of color: A systematic review. JAMA Dermatology, 158, 542.

    Article  PubMed  Google Scholar 

  48. Gloster, H. M., Jr., & Neal, K. (2006). Skin cancer in skin of color. Journal of the American Academy of Dermatology, 55(5), 741–760.

    Article  PubMed  Google Scholar 

  49. Ridky, T. W. (2007). Nonmelanoma skin cancer. Journal of the American Academy of Dermatology, 57(3), 484–501.

    Article  PubMed  Google Scholar 

  50. Higgins, S., Nazemi, A., Chow, M., & Wysong, A. (2018). Review of nonmelanoma skin cancer in African Americans, Hispanics, and Asians. Dermatologic Surgery, 44(7), 903–910.

    Article  CAS  PubMed  Google Scholar 

  51. Gloster, H. M., Jr., & Brodland, D. G. (1996). The epidemiology of skin cancer. Dermatologic Surgery, 22(3), 217–226.

    Article  PubMed  Google Scholar 

  52. American Cancer Society. (2022). Cancer facts & figures 2022. American Cancer Society.

    Google Scholar 

  53. Yamaguchi, Y., Takahashi, K., Zmudzka, B. Z., Kornhauser, A., Miller, S. A., Tadokoro, T., Berens, W., Beer, J. Z., Hearing, V. J., Yamaguchi, Y., & Takahashi, K. (2006). Human skin responses to UV radiation: Pigment in the upper epidermis protects against DNA damage in the lower epidermis and facilitates apoptosis. The FASEB Journal, 20(9), 1486–1488.

    Article  CAS  PubMed  Google Scholar 

  54. Gupta, A. K., Bharadwaj, M., & Mehrotra, R. (2016). Skin cancer concerns in people of color: Risk factors and prevention. Asian Pacific Journal of Cancer Prevention: APJCP, 17(12), 5257.

    PubMed  PubMed Central  Google Scholar 

  55. Battie, C., Gohara, M., Verschoore, M., & Roberts, W. (2013). Skin cancer in skin of color: An update on current facts, trends, and misconceptions. Journal of Drugs in Dermatology: JDD, 12(2), 194–198.

    PubMed  Google Scholar 

  56. Reeder, V. J., Gustafson, C. J., Mireku, K., Davis, S. A., Feldman, S. R., & Pearce, D. J. (2015). Trends in Mohs surgery from 1995 to 2010: An analysis of nationally representative data. Dermatologic Surgery, 41(3), 397–403.

    Article  CAS  PubMed  Google Scholar 

  57. Kaufman, B. P., & Alexis, A. F. (2017). Skin cancer mortality in patients with skin of color. Cutis, 99(5), 307–308.

    PubMed  Google Scholar 

  58. Dawes, S. M., Tsai, S., Gittleman, H., Barnholtz-Sloan, J. S., & Bordeaux, J. S. (2016). Racial disparities in melanoma survival. Journal of the American Academy of Dermatology, 75(5), 983–991.

    Article  PubMed  Google Scholar 

  59. Conic, R. Z., Cabrera, C. I., Khorana, A. A., & Gastman, B. R. (2018). Determination of the impact of melanoma surgical timing on survival using the National Cancer Database. Journal of the American Academy of Dermatology, 78(1), 40–46.

    Article  PubMed  Google Scholar 

  60. Tripathi, R., Archibald, L. K., Mazmudar, R. S., Conic, R. R., Rothermel, L. D., Scott, J. F., & Bordeaux, J. S. (2020). Racial differences in time to treatment for melanoma. Journal of the American Academy of Dermatology, 83(3), 854–859.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Davis, D. S., Robinson, C., & Callender, V. D. (2021). Skin cancer in women of color: Epidemiology, pathogenesis and clinical manifestations. International Journal of Women’s Dermatology, 7(2), 127–134.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Frederick, J. E., Snell, H. E., & Haywood, E. K. (1989). Solar ultraviolet radiation at the earth’s surface. Photochemistry and Photobiology, 50(4), 443–450.

    Article  CAS  Google Scholar 

  63. Cohen, L., Brodsky, M. A., Zubair, R., Kohli, I., Hamzavi, I. H., & Sadeghpour, M. (2020). Cutaneous interaction with visible light: What do we know. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.03.115

  64. Liebel, F., Kaur, S., Ruvolo, E., Kollias, N., & Southall, M. D. (2012). Irradiation of skin with visible light induces reactive oxygen species and matrix-degrading enzymes. Journal of Investigative Dermatology, 132(7), 1901–1907.

    Article  CAS  PubMed  Google Scholar 

  65. Ezekwe, N., Maghfour, J., & Kohli, I. (2022). Visible light and the skin. Photochemistry and photobiology. https://doi.org/10.1111/php.13634

    Article  PubMed  Google Scholar 

  66. Cho, S., Lee, M. J., Kim, M. S., Lee, S., Kim, Y. K., Lee, D. H., Lee, C. W., Cho, K. H., & Chung, J. H. (2008). Infrared plus visible light and heat from natural sunlight participate in the expression of MMPs and type I procollagen as well as infiltration of inflammatory cell in human skin in vivo. Journal of Dermatological Science, 50(2), 123–133.

    Article  CAS  PubMed  Google Scholar 

  67. Pourang, A., Tisack, A., Ezekwe, N., Torres, A. E., Kohli, I., Hamzavi, I. H., & Lim, H. W. (2022). Effects of visible light on mechanisms of skin photoaging. Photodermatology, Photoimmunology & Photomedicine, 38(3), 191–196.

    Article  CAS  Google Scholar 

  68. Haywood, R. (2006). Relevance of sunscreen application method, visible light and sunlight intensity to free-radical protection: A study of ex vivo human skin. Photochemistry and Photobiology, 82(4), 1123–1131.

    Article  CAS  PubMed  Google Scholar 

  69. Hudson, L., Rashdan, E., Bonn, C. A., Chavan, B., Rawlings, D., & Birch-Machin, M. A. (2020). Individual and combined effects of the infrared, visible, and ultraviolet light components of solar radiation on damage biomarkers in human skin cells. The FASEB Journal, 34(3), 3874–3883.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Mahmoud, B. H., Hexsel, C. L., Hamzavi, I. H., & Lim, H. W. (2008). Effects of visible light on the skin. Photochemistry and Photobiology, 84(2), 450–462.

    Article  CAS  PubMed  Google Scholar 

  71. Kielbassa, C., Roza, L., & Epe, B. (1997). Wavelength dependence of oxidative DNA damage induced by UV and visible light. Carcinogenesis, 18(4), 811–816.

    Article  CAS  PubMed  Google Scholar 

  72. Callender, V. D., Baldwin, H., Cook-Bolden, F. E., Alexis, A. F., Stein Gold, L., & Guenin, E. (2022). Effects of topical retinoids on acne and post-inflammatory hyperpigmentation in patients with skin of color: A clinical review and implications for practice. American Journal of Clinical Dermatology, 23(1), 69–81.

    Article  PubMed  Google Scholar 

  73. Davis, E. C., & Callender, V. D. (2010). Postinflammatory hyperpigmentation: A review of the epidemiology, clinical features, and treatment options in skin of color. The Journal of Clinical and Aesthetic Dermatology, 3(7), 20.

    PubMed  PubMed Central  Google Scholar 

  74. Ortonne, J. P., & Bissett, D. L. (2008). Latest insights into skin hyperpigmentation. Journal of Investigative Dermatology Symposium Proceedings, 13(1), 10–14.

    Article  PubMed  Google Scholar 

  75. Porges, S. B., Kaidbey, K. H., & Grove, G. L. (1988). Quantification of visible light-induced melanogenesis in human skin. Photo-dermatology, 5(5), 197–200.

    CAS  PubMed  Google Scholar 

  76. Rosen, C. F., Jacques, S. L., Stuart, M. E., & Gange, R. W. (1990). Immediate pigment darkening: Visual and reflectance spectrophotometric analysis of action spectrum. Photochemistry and Photobiology, 51(5), 583–588.

    Article  CAS  PubMed  Google Scholar 

  77. Mahmoud, B. H., Ruvolo, E., Hexsel, C. L., Liu, Y., Owen, M. R., Kollias, N., Lim, H. W., & Hamzavi, I. H. (2010). Impact of long-wavelength UVA and visible light on melanocompetent skin. Journal of Investigative Dermatology, 130(8), 2092–2097.

    Article  CAS  PubMed  Google Scholar 

  78. Duteil, L., Cardot-Leccia, N., Queille-Roussel, C., Maubert, Y., Harmelin, Y., Boukari, F., Ambrosetti, D., Lacour, J. P., & Passeron, T. (2014). Differences in visible light-induced pigmentation according to wavelengths: A clinical and histological study in comparison with UVB exposure. Pigment Cell & Melanoma Research, 27(5), 822–826.

    Article  CAS  Google Scholar 

  79. Regazzetti, C., Sormani, L., Debayle, D., Bernerd, F., Tulic, M. K., De Donatis, G. M., Chignon-Sicard, B., Rocchi, S., & Passeron, T. (2018). Melanocytes sense blue light and regulate pigmentation through opsin-3. Journal of Investigative Dermatology, 138(1), 171–178.

    Article  CAS  PubMed  Google Scholar 

  80. Jansen, R., Wang, S. Q., Burnett, M., Osterwalder, U., & Lim, H. W. (2013). Photoprotection: Part I. Photoprotection by naturally occurring, physical, and systemic agents. Journal of the American Academy of Dermatology, 69(6), 8531.

    Article  Google Scholar 

  81. Friedman, L. C., Bruce, S., Weinberg, A. D., Cooper, H. P., Yen, A. H., & Hill, M. (1994). Early detection of skin cancer: Racial/ethnic differences in behaviors and attitudes. Journal of Cancer Education, 9(2), 105–110.

    CAS  PubMed  Google Scholar 

  82. Perlman, K. L., Williams, N. M., Egbeto, I. A., Gao, D. X., Siddiquee, N., & Park, J. H. (2021). Skin of color lacks representation in medical student resources: A cross-sectional study. International Journal of Women’s Dermatology, 7(2), 195.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Lester, J. C., Taylor, S. C., & Chren, M. M. (2019). Under-representation of skin of colour in dermatology images: Not just an educational issue. The British Journal of Dermatology, 180(6), 1521–1522.

    Article  CAS  PubMed  Google Scholar 

  84. Song, H., Beckles, A., Salian, P., & Porter, M. L. (2021). Sunscreen recommendations for patients with skin of color in the popular press and in the dermatology clinic. International Journal of Women’s Dermatology, 7(2), 165–170.

    Article  PubMed  Google Scholar 

  85. Akamine, K. L., Gustafson, C. J., Davis, S. A., Levender, M. M., & Feldman, S. R. (2014). Trends in sunscreen recommendation among US physicians. JAMA Dermatology, 150(1), 51–55.

    Article  PubMed  Google Scholar 

  86. Rigel, D. S., Taylor, S. C., Lim, H. W., Alexis, A. F., Armstrong, A. W., Fuxench, Z. C., Draelos, Z. D., & Hamzavi, I. H. (2022). Photoprotection for skin of all color: Consensus and clinical guidance from an expert panel. Journal of the American Academy of Dermatology, 86(3), S1-8.

    Article  PubMed  Google Scholar 

  87. Schalka, S., & Reis, V. M. S. D. (2011). Sun protection factor: Meaning and controversies. Anais brasileiros de dermatologia, 86, 507–515.

    Article  PubMed  Google Scholar 

  88. Hedayat, K., Nasrollahi, S. A., Firooz, A., Rastegar, H., & Dadgarnejad, M. (2020). Comparison of UVA protection factor measurement protocols. Clinical, Cosmetic and Investigational Dermatology, 13, 351.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. ISO 24442: 2011. (2011). Cosmetics—Sun protection test methods—In vivo determination of sunscreen UVA protection. ISO.

    Google Scholar 

  90. Wang, S. Q., Xu, H., Stanfield, J. W., Osterwalder, U., & Herzog, B. (2017). Comparison of ultraviolet A light protection standards in the United States and European Union through in vitro measurements of commercially available sunscreens. Journal of the American Academy of Dermatology, 77(1), 42–47.

    Article  CAS  PubMed  Google Scholar 

  91. European Commission (n.d.) Sunscreen products. Retrieved June 21, 2022, from https://ec.europa.eu/growth/sectors/cosmetics/cosmetic-products-specific-topics/sunscreen-products_en

  92. Food and Drug Administration, HHS. (2012). Labeling and effectiveness testing; sunscreen drug products for over-the-counter human use; delay of compliance dates. Final rule; delay of compliance dates; request for comments. Federal Register, 77(92), 27591–27593.

    Google Scholar 

  93. Lim, H. W., Kohli, I., Granger, C., Trullàs, C., Piquero-Casals, J., Narda, M., Masson, P., Krutmann, J., & Passeron, T. (2021). Photoprotection of the skin from visible light-induced pigmentation: Current testing methods and proposed harmonization. Journal of Investigative Dermatology, 141(11), 2569–2576.

    Article  CAS  PubMed  Google Scholar 

  94. Passeron, T., Lim, H. W., Goh, C. L., Kang, H. Y., Ly, F., Morita, A., Ocampo Candiani, J., Puig, S., Schalka, S., Wei, L., & Dréno, B. (2021). Photoprotection according to skin phototype and dermatoses: Practical recommendations from an expert panel. Journal of the European Academy of Dermatology and Venereology, 35(7), 1460–1469.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Lyons, A. B., Trullas, C., Kohli, I., Hamzavi, I. H., & Lim, H. W. (2021). Photoprotection beyond ultraviolet radiation: A review of tinted sunscreens. Journal of the American Academy of Dermatology, 84(5), 1393–1397.

    Article  CAS  PubMed  Google Scholar 

  96. Guan, L. L., Lim, H. W., & Mohammad, T. F. (2021). Sunscreens and photoaging: A review of current literature. American Journal of Clinical Dermatology, 22(6), 819–828.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Marionnet, C., de Dormael, R., Marat, X., Roudot, A., Gizard, J., Planel, E., Tornier, C., Golebiewski, C., Bastien, P., Candau, D., & Bernerd, F. (2022). Sunscreens with the new MCE filter cover the whole UV spectrum: Improved UVA1 photoprotection in vitro and in a randomized controlled trial. JID Innovations, 2(1), 100070.

    Article  PubMed  Google Scholar 

  98. Bacqueville, D., Jacques-Jamin, C., Lapalud, P., Douki, T., Roullet, N., Sereno, J., Redoulès, D., Bessou-Touya, S., & Duplan, H. (2022). Formulation of a new broad-spectrum UVB+ UVA and blue light SPF50+ sunscreen containing Phenylene Bis-Diphenyltriazine (TriAsorB), an innovative sun filter with unique optical properties. Journal of the European Academy of Dermatology and Venereology, 36, 29–37.

    Article  CAS  PubMed  Google Scholar 

  99. Lawrence, K. P., Sarkany, R. P., Acker, S., Herzog, B., & Young, A. R. (2022). A new visible light absorbing organic filter offers superior protection against pigmentation by wavelengths at the UVR-visible boundary region. Journal of Photochemistry and Photobiology B: Biology, 227, 112372.

    Article  CAS  PubMed  Google Scholar 

  100. Neale, R. E., Khan, S. R., Lucas, R. M., Waterhouse, M., Whiteman, D. C., & Olsen, C. M. (2019). The effect of sunscreen on vitamin D: A review. British Journal of Dermatology, 181(5), 907–915.

    Article  CAS  PubMed  Google Scholar 

  101. Passeron, T., Bouillon, R., Callender, V., Cestari, T., Diepgen, T. L., Green, A. C., van der Pols, J. C., Bernard, B. A., Ly, F., Bernerd, F., & Marrot, L. (2019). Sunscreen photoprotection and vitamin D status. British Journal of Dermatology, 181(5), 916–931.

    Article  CAS  PubMed  Google Scholar 

  102. Afarideh, M., Sartori-Valinotti, J. C., & Tollefson, M. M. (2021). Association of sun-protective behaviors with bone mineral density and osteoporotic bone fractures in US adults. JAMA Dermatology, 157(12), 1437–1446.

    Article  PubMed  Google Scholar 

  103. Fatima, S., Braunberger, T., Mohammad, T. F., Kohli, I., & Hamzavi, I. H. (2020). The role of sunscreen in melasma and postinflammatory hyperpigmentation. Indian Journal of Dermatology, 65(1), 5.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Chan, H. H., Alam, M., Kono, T., & Dover, J. S. (2002). Clinical application of lasers in Asians. Dermatologic surgery, 28(7), 556–563.

    PubMed  Google Scholar 

  105. Wanitphakdeedecha, R., Phuardchantuk, R., & Manuskiatti, W. (2014). The use of sunscreen starting on the first day after ablative fractional skin resurfacing. Journal of the European Academy of Dermatology and Venereology, 28(11), 1522–1528.

    Article  CAS  PubMed  Google Scholar 

  106. Halder, R., Rodney, I., Munhutu, M., Foltis, P., Battie, C., Verschoore, M., & Oresajo, C. (2015). Evaluation and effectiveness of a photoprotection composition (sunscreen) on subjects of skin of color. JAMA Dermatology, 72(5), AB215.

    Google Scholar 

  107. Lakhdar, H., Zouhair, K., Khadir, K., Essari, A., Richard, A., Seité, S., & Rougier, A. (2007). Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women. Journal of the European Academy of Dermatology and Venereology, 21(6), 738–742.

    Article  CAS  PubMed  Google Scholar 

  108. Sarkar, R., Ghunawat, S., Narang, I., Verma, S., Garg, V. K., & Dua, R. (2019). Role of broad-spectrum sunscreen alone in the improvement of melasma area severity index (MASI) and Melasma Quality of Life Index in melasma. Journal of Cosmetic Dermatology, 18(4), 1066–1073.

    PubMed  Google Scholar 

  109. Kelm, R. C., Zahr, A. S., Kononov, T., & Ibrahim, O. (2020). Effective lightening of facial melasma during the summer with a dual regimen: A prospective, open-label, evaluator-blinded study. Journal of Cosmetic Dermatology, 19(12), 3251–3257.

    Article  PubMed  Google Scholar 

  110. Guevara, I. L., & Pandya, A. G. (2003). Safety and efficacy of 4% hydroquinone combined with 10% glycolic acid, antioxidants, and sunscreen in the treatment of melasma. International Journal of Dermatology, 42(12), 966–972.

    Article  CAS  PubMed  Google Scholar 

  111. Navarrete-Solís, J., Castanedo-Cázares, J. P., Torres-Álvarez, B., Oros-Ovalle, C., Fuentes-Ahumada, C., González, F. J., Martínez-Ramírez, J. D., & Moncada, B. (2011). A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma. Dermatology Research and Practice, 2011, 1–5.

    Article  Google Scholar 

  112. Lima, P. B., Dias, J. A. F., Cassiano, D. P., Esposito, A. C. C., Miot, L. D. B., Bagatin, E., & Miot, H. A. (2021). Efficacy and safety of topical isobutylamido thiazolyl resorcinol (Thiamidol) versus 4% hydroquinone cream for facial melasma: An evaluator-blinded, randomized controlled trial. Journal of the European Academy of Dermatology and Venereology, 35(9), 1881–1887.

    Article  CAS  PubMed  Google Scholar 

  113. Lim, H. W., Kohli, I., Ruvolo, E., Kolbe, L., & Hamzavi, I. H. (2022). Impact of visible light on skin health: The role of antioxidants and free radical quenchers in skin protection. Journal of the American Academy of Dermatology, 86(3), S27–S37.

    Article  CAS  PubMed  Google Scholar 

  114. Solano, F. (2020). Photoprotection and skin pigmentation: Melanin-related molecules and some other new agents obtained from natural sources. Molecules, 25(7), 1537.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. Pullar, J. M., Carr, A. C., & Vissers, M. C. (2017). The roles of vitamin C in skin health. Nutrients, 9(8), 866.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Rhie, G. E., Shin, M. H., Seo, J. Y., Choi, W. W., Cho, K. H., Kim, K. H., Park, K. C., Eun, H. C., & Chung, J. H. (2001). Aging-and photoaging-dependent changes of enzymic and nonenzymic antioxidants in the epidermis and dermis of human skin in vivo. Journal of Investigative Dermatology, 117(5), 1212–1217.

    Article  CAS  PubMed  Google Scholar 

  117. Lin, F. H., Lin, J. Y., Gupta, R. D., Tournas, J. A., Burch, J. A., Selim, M. A., Monteiro-Riviere, N. A., Grichnik, J. M., Zielinski, J., & Pinnell, S. R. (2005). Ferulic acid stabilizes a solution of vitamins C and E and doubles its photoprotection of skin. Journal of Investigative Dermatology, 125(4), 826–832.

    Article  CAS  PubMed  Google Scholar 

  118. Lin, J. Y., Selim, M. A., Shea, C. R., Grichnik, J. M., Omar, M. M., Monteiro-Riviere, N. A., & Pinnell, S. R. (2003). UV photoprotection by combination topical antioxidants vitamin C and vitamin E. Journal of the American Academy of Dermatology, 48(6), 866–874.

    Article  PubMed  Google Scholar 

  119. Murray, J. C., Burch, J. A., Streilein, R. D., Iannacchione, M. A., Hall, R. P., & Pinnell, S. R. (2008). A topical antioxidant solution containing vitamins C and E stabilized by ferulic acid provides protection for human skin against damage caused by ultraviolet irradiation. Journal of the American Academy of Dermatology, 59(3), 418–425.

    Article  PubMed  Google Scholar 

  120. Traikovich, S. S. (1999). Use of topical ascorbic acid and its effects on photodamaged skin topography. Archives of Otolaryngology–Head & Neck Surgery, 125(10), 1091–1098.

    Article  CAS  Google Scholar 

  121. Delinasios, G. J., Karbaschi, M., Cooke, M. S., & Young, A. R. (2018). Vitamin E inhibits the UVAI induction of “light” and “dark” cyclobutane pyrimidine dimers, and oxidatively generated DNA damage, in keratinocytes. Scientific Reports, 8(1), 1–12.

    Google Scholar 

  122. Lyons, A. B., Zubair, R., Kohli, I., Nahhas, A. F., Braunberger, T. L., Mokhtari, M., Ruvolo, E., Lim, H. W., & Hamzavi, I. H. (2022). Mitigating visible light and long wavelength UVA1-induced effects with topical antioxidants. Photochemistry and Photobiology, 98(2), 455–460.

    Article  CAS  PubMed  Google Scholar 

  123. Ruvolo, E., Boothby-Shoemaker, W., Kumar, N., Hamzavi, I. H., Lim, H. W., & Kohli, I. (2022). Evaluation of efficacy of antioxidant-enriched sunscreen prodcuts against long wavelength ultraviolet al and visible light. International Journal of Cosmetic Science, 44, 394–402.

    Article  CAS  PubMed  Google Scholar 

  124. Kern, J., Wood, E., Almukhtar, R., Angra, K., Lipp, M., & Goldman, M. (2022). Evaluation of an SPF50 sunscreen containing photolyase and antioxidants for its anti-photoaging properties and photoprotection. Journal of Drugs in Dermatology: JDD, 21(5), 517–520.

    Article  PubMed  Google Scholar 

  125. Torres, A. E., Awosika, O., Maghfour, J., Taylor, S., & Lim, H. W. (2022). Practical guide to tinted sunscreens. Journal of the American Academy of Dermatology, 87(3), 656–657.

    Article  PubMed  Google Scholar 

  126. Berry, E. G., Bezecny, J., Acton, M., Sulmonetti, T. P., Anderson, D. M., Beckham, H. W., Durr, R. A., Chiba, T., Beem, J., Brash, D. E., & Kulkarni, R. (2022). Slip versus Slop: A head-to-head comparison of UV-protective clothing to sunscreen. Cancers, 14(3), 542.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  127. Linos, E., Keiser, E., Fu, T., Colditz, G., Chen, S., & Tang, J. Y. (2011). Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness. Cancer Causes & Control, 22(7), 1067–1071.

    Article  Google Scholar 

  128. Thieden, E., Philipsen, P. A., Sandby-Møller, J., & Wulf, H. C. (2005). Sunscreen use related to UV exposure, age, sex, and occupation based on personal dosimeter readings and sun-exposure behavior diaries. Archives of Dermatology, 141(8), 967–973.

    Article  PubMed  Google Scholar 

  129. Autier, P., Boniol, M., & Doré, J. F. (2007). Sunscreen use and increased duration of intentional sun exposure: Still a burning issue. International Journal of Cancer, 121(1), 1–5.

    Article  CAS  PubMed  Google Scholar 

  130. Tsai, J., & Chien, A. L. (2022). Photoprotection for skin of color. American Journal of Clinical Dermatology, 23, 1–11.

    Article  Google Scholar 

  131. Andreeva, V. A., Unger, J. B., Yaroch, A. L., Cockburn, M. G., Baezconde-Garbanati, L., & Reynolds, K. D. (2009). Acculturation and sun-safe behaviors among US Latinos: Findings from the 2005 Health Information National Trends Survey. American Journal of Public Health, 99(4), 734–741.

    Article  PubMed  PubMed Central  Google Scholar 

  132. Patel, S. P., & Chien, A. L. (2021). Sun protective clothing and sun avoidance: The most critical components of photoprotection in patients with melanoma. Dermatologic Surgery, 47(3), 333–337.

    CAS  PubMed  Google Scholar 

  133. Gambichler, T., Altmeyer, P., & Hoffmann, K. (2002). Role of clothes in sun protection. In R. Dummer, F. O. Nestle, & G. Burg (Eds.), Cancers of the skin (pp. 15–25). Springer.

    Chapter  Google Scholar 

  134. Louris, E., Sfiroera, E., Priniotakis, G., Makris, R., Siemos, H., Efthymiou, C., & Assimakopoulos, M. N. (2018). Evaluating the ultraviolet protection factor (UPF) of various knit fabric structures. IOP Conference Series: Materials Science and Engineering, 459(1), 012051.

    Article  Google Scholar 

  135. Boothby-Shoemaker, W. T., Mohammad, T. F., Ozog, D. M., & Lim, H. W. (2022). Photoprotection by clothing: A review. Photodermatology, Photoimmunology & Photomedicine, 38, 478–488.

    Article  CAS  Google Scholar 

  136. Adam, J. (1998). Sun-protective clothing. Journal of Cutaneous Medicine and Surgery, 3(1), 50–53.

    Article  CAS  PubMed  Google Scholar 

  137. Parrado, C., Philips, N., Gilaberte, Y., Juarranz, A., & Gonzalez, S. (2018). Oral photoprotection: Effective agents and potential candidates. Frontiers in Medicine, 5, 188.

    Article  PubMed  PubMed Central  Google Scholar 

  138. Bendich, A., & Olson, J. A. (1989). Biological actions of carotenoids 1. The FASEB Journal, 3(8), 1927–1932.

    Article  CAS  PubMed  Google Scholar 

  139. Eberlein-König, B., Placzek, M., & Przybilla, B. (1998). Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-α-tocopherol (vitamin E). Journal of the American Academy of Dermatology, 38(1), 45–48.

    Article  PubMed  Google Scholar 

  140. Cesarini, J. P., Michel, L., Maurette, J. M., Adhoute, H., & Bejot, M. (2003). Immediate effects of UV radiation on the skin: Modification by an antioxidant complex containing carotenoids. Photodermatology, Photoimmunology & Photomedicine, 19(4), 182–189.

    Article  CAS  Google Scholar 

  141. Fuchs, J., & Kern, H. (1998). Modulation of UV-light-induced skin inflammation by D-alpha-tocopherol and l-ascorbic acid: A clinical study using solar simulated radiation. Free Radical Biology and Medicine, 25(9), 1006–1012.

    Article  CAS  PubMed  Google Scholar 

  142. Choudhry, S. Z., Bhatia, N., Ceilley, R., Hougeir, F., Lieberman, R., Hamzavi, I., & Lim, H. W. (2014). Role of oral polypodium leucotomos extract in dermatologic diseases: A review of the literature. Journal of Drugs in Dermatology, 13(2), 148–153.

    PubMed  Google Scholar 

  143. Mohammad, T. F., Kohli, I., Nicholson, C. L., Treyger, G., Chaowattanapanit, S., Lim, H. W., & Hamzavi, I. (2019). Oral polypodium leucotomos extract and its impact on visible light-induced pigmentation in human subjects. Journal of Drugs in Dermatology, 18(12), 1198-I203.

    CAS  PubMed  Google Scholar 

  144. Truchuelo, M. T., Jiménez, N., Días, I. J., Gallego-Rentero, M., & Alonso-Juarranz, M. (2019). A pilot study to assess the effects of an oral photo protector of botanical origin against visible and infrared radiations in human volunteers. The Journal of Dermatology, 6(282), 2.

    Google Scholar 

  145. Goh, C. L., Chuah, S. Y., Tien, S., Thng, G., Vitale, M. A., & Delgado-Rubin, A. (2018). Double-blind, placebo-controlled trial to evaluate the effectiveness of Polypodium leucotomos extract in the treatment of melasma in Asian skin: A pilot study. The Journal of Clinical and Aesthetic Dermatology, 11(3), 14.

    PubMed  PubMed Central  Google Scholar 

  146. Ahmed, A. M., Lopez, I., Perese, F., Vasquez, R., Hynan, L. S., Chong, B., & Pandya, A. G. (2013). A randomized, double-blinded, placebo-controlled trial of oral Polypodium leucotomos extract as an adjunct to sunscreen in the treatment of melasma. JAMA Dermatology, 149(8), 981–983.

    Article  PubMed  Google Scholar 

  147. Ni, Z., Mu, Y., & Gulati, O. (2002). Treatment of melasma with pycnogenol®. Phytotherapy Research: An International Journal Devoted to Pharmacological and Toxicological Evaluation of Natural Product Derivatives, 16(6), 567–571.

    Article  CAS  Google Scholar 

  148. Aladrén, S., Garre, A., Valderas-Martínez, P., Piquero-Casals, J., & Granger, C. (2019). Efficacy and safety of an oral nutritional (dietary) supplement containing pinus pinaster bark extract and grape seed extract in combination with a high SPF sunscreen in the treatment of mild-to-moderate melasma: A prospective clinical study. Cosmetics, 6(1), 15.

    Article  Google Scholar 

  149. Torres, A. E., Luk, K. M., & Lim, H. W. (2020). Botanicals for photoprotection. Plastic and Aesthetic Research, 7, 57.

    Google Scholar 

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  1. Sokhna Seck and Judy Hamad are co-first authors.

Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Sokhna Seck

  2. Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, Henry Ford Medical Center – New Center One, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA

    Judy Hamad & Henry W. Lim

  3. Medcin Skin Research Center, São Paulo, Brazil

    Sergio Schalka

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SSeck and JH have no conflict to disclose. SSchalka has served as consultant for ISDIN and FQM Brasil and as a speaker for Pierre Fabre, La Roche Posay and Bioderma. HWL has served as investigator for Incyte, La Roche-Posay, Pfizer, and PCORI, as a consultant for Pierre Fabre, ISDIN, Ferndale, La Roche-Posay, and Beiersdorf, and as a speaker on general educational session sponsored by La Roche-Posay, Pierre Fabre and Bioderma.

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Seck, S., Hamad, J., Schalka, S. et al. Photoprotection in skin of color. Photochem Photobiol Sci 22, 441–456 (2023). https://doi.org/10.1007/s43630-022-00314-z

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