One size fits nobody.
A panel of twelve dermatology experts have argued that sunscreen should be prescribed in a bespoke manner in order to optimise photoprotection.
Knowledge around the damage caused by ultraviolet (UV) radiation has truly evolved since the 1960s, when it was first postulated that UV-induced skin cancer is probably the result of photochemical changes in DNA. We now know a great deal more about the impact of different wavelengths of light on the skin, relating to cellular damage and repair mechanisms, oxidative stress, and inflammation of the skin. We can recognise that individuals are affected by light in different ways.
Despite these advances, the industry standard for comparing sunscreens used today has not changed since Sun Protection Factor, or SPF, was introduced 1974.
The main issues with SPF are that it is only a narrow measure of protection against UVB radiation (280-315 nm), and does not take into account light protection requirement differences between individuals. For example, the article emphasises that UVA (315-400nm), visible light (400-700nm) and infrared A (IRA; >700nm) penetrate deeply and cause photoaging, therefore protection against all these wavelengths is beneficial to all skin phototypes. Conversely, lighter skin types experience greater DNA damage and less efficient repair processes than darker phototypes, therefore require a higher level of protection from UVB. However, people with darker skin are more prone to hyperpigmentation induced by visible light and UVA.
In response, the authors of this review, an international panel of 12 experts, developed a set of recommendations to support clinicians on the type of sunscreen to prescribe depending on skin phototype and dermatoses.
A selection of their recommendations is highlighted in the table below. The results indicate that photoprotection should be tailored to different skin phototypes.
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|Recommendation FROM PASSERON ET AL (2021)|
|For dark skin, sunscreen with SPF30+ and an SPF/UVA-PF ratio of <1.5 is recommended.
For light skin, SPF50+ and an SPF/UVA-PF ratio of <3 is recommended.
|The need for visible light protection for the prevention of photoageing is not yet clear but should be recommended to avoid actinic lentigines.
Daily use of sunscreen with a balanced UVB/UVA protection is very important to prevent photoageing all year round in all skin phototypes.
|Sunscreens with high SPF and good UVA protection, SPF50+ and an SPF/UVA-PF ratio close to 1, are recommended for melanoma prevention in fair-skinned individuals.
For actinic keratosis and squamous cell carcinoma, a well-balanced sunscreen with SPF50+ and with an SPF/UVA-PF ratio <3 with protection is recommended.
Solar urticaria/solar angioedema
|Antihistamines and total sun avoidance remain the mainstay treatment. Broad-spectrum sunscreens with UVB, UVA and visible light photoprotection (tinted sunscreen) are recommended.|
|Cutaneous porphyrias||Physical protection and sun avoidance is recommended in severe cases due to the difficulty of protecting against visible light. In areas not covered by clothes, a sunscreen with visible light photoprotection (tinted sunscreen) is recommended.|
|Vitiligo||Vitiligo patients should be advised to regularly expose their lesional skin to UV radiation without sunscreen until their vitiligo lesions start becoming pink. When the vitiligo lesions are pink or repigmented, SPF50+ broad-spectrum sunscreen is recommended to prevent sunburn that could cause Koebnerization.|
|Use of an SPF30+ broad-spectrum sunscreen with good UVB and UVA protection, as well as VL protection (sun hats and shade), are strongly recommended for retentional acne with signs of PIH or for patients at high risk of PIH, e.g., Fitzpatrick skin type IV or higher, or if significant occupational, or recreational sun exposure.
Although sunscreen containing zinc oxide may be recommended to decrease risks of phototoxicity of both topical and systemic acne drugs, transparency is important to reduce white residues, especially for darker skin types; teenagers with acne generally prefer a mist formula.