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Cited by 68Skin Protection and Agingmelanin and skin pigmentationNonmelanoma Skin Cancer Studies

Photoprotection for skin of color

Open access
Tsai, Jerry, Chien, Anna L.·2022·American Journal of Clinical Dermatology
DOI 10.1007/s40257-021-00670-zPMC PMC8766623
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Abstract

Photoprotection behaviors can mitigate skin damage caused by ultraviolet radiation, and common methods include seeking shade, avoiding sun exposure during peak daylight hours, wearing sun-protective clothing, applying sunscreen, and using sunglasses. While the role of sun protection in preventing sunburns, photoaging, and skin cancer is well established in fair-skinned populations, individuals with skin of color (SOC) are presumed to suffer fewer negative effects from solar radiation. Thus, the importance of photoprotection in this population is understudied and may be underestimated. In SOC populations, sun exposure is known to cause pigmentary disorders, photoaging, and basal cell carcinoma (BCC), highlighting the potential benefits of photoprotection. Although SOC populations tend to practice photoprotection by seeking shade and wearing sun-protective clothing, survey and interview-based studies have consistently found relatively low use of sunscreen among these populations. Common motivators for photoprotection in individuals with SOC include preventing sunburn and pigmentation, with the prevention of skin cancer being a less important reason. As a skin cancer risk behavior, indoor tanning is relatively rare in SOC populations, but its use may increase with acculturation to US norms. While more studies are necessary to clarify whether photoprotection behaviors may decrease skin cancer-related mortality in SOC populations, regular dermatologic care and counseling on photoprotection remain essential in patients with SOC for overall skin health.

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Registry

Crossref · 10.1007/s40257-021-00670-z

Cites

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Statistics

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Claims the paper makes

0 of 99 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    In fair-skinned populations, photoprotection is established to prevent sunburn and long-term photoaging and photocarcinogenesis.

    “While the role of photoprotection in preventing sunburns and the long-term consequences of sun exposure (e.g., photoaging, photocarcinogenesis) is well established in fair-skinned populations”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] American Academy of Dermatology. Prevent skin cancer. 2021. https://www.aad.org/public/diseases/skin-cancer/prevent/how. Cited 1 Oct 2021.

      Not checked in the free run.

  • Premisecitation

    Using sun protection can reduce skin injury caused by ultraviolet light.

    “Photoprotection behaviors can prevent skin damage by ultraviolet (UV) radiation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] American Academy of Dermatology. Prevent skin cancer. 2021. https://www.aad.org/public/diseases/skin-cancer/prevent/how. Cited 1 Oct 2021.

      Not checked in the free run.

  • Interpretationcitation

    Photoprotection methods such as sun avoidance and sunscreen use are essential to prevent development and worsening of PIH and melasma.

    “The practice of photoprotection methods such as sun avoidance and sunscreen use are essential to prevent the development and worsening of PIH and melasma [37, 38].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Kaufman BP, Aman T, Alexis AF. Postinflammatory hyperpigmentation: epidemiology, clinical presentation, pathogenesis and treatment. Am J Clin Dermatol. 2018;19(4):489–503. source

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    • cites [38] Halder RM, Nootheti PK. Ethnic skin disorders overview. J Am Acad Dermatol. 2003;48(6):S143–8. source

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  • Interpretationnone given

    Despite increased photoprotection from darker skin, individuals with SOC are more susceptible to certain pigmentary disorders.

    “Despite increased photoprotection provided by darker skin, individuals with SOC are more susceptible to developing certain pigmentary disorders.”
    Quote in the paperSubstantial claim
  • Premisecitation

    UV radiation, especially UVB, is associated with development of melanoma and non-melanoma skin cancer (BCC, SCC).

    “UV radiation, especially UVB radiation, is associated with the development of melanoma and non-melanoma skin cancer (NMSC; e.g., basal cell carcinoma [BCC], squamous cell carcinoma [SCC]) [6, 65].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol. 2008;84(3):539–49. source

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    • cites [65] Subhadarshani S, Athar M, Elmets CA. Photocarcinogenesis. Curr Derm Rep. 2020;9(3):189–99. source

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  • May combine two claims. 29
  • Classified as probably not a substantial claim. 9
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Melanin contributes significantly to differences in skin pigmentation between light- and dark-skinned individuals and to tanning after UV exposure.

    “melanin contributes significantly to differences in skin pigmentation between light- and dark-skinned individuals, as well as darkening of the skin (i.e., tanning) after UV exposure [4–6].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [4] Quevedo WC, Fitzpatrick TB, Pathak MA, Jimbow K. Role of light in human skin color variation. Am J Phys Anthropol. 1975;43(3):393–408. source

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    • cites [5] Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol. 2000;39(1):57–106. source

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    • cites [6] Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol. 2008;84(3):539–49. source

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  • May combine two claims.

    Premisecitation

    Darker skin tends to have higher melanin content and more melanosomes than lighter skin, but melanocyte number does not differ.

    “Compared with lighter skin, darker skin tends to have higher melanin content and number of melanosomes, but no difference in the number of melanocytes is seen [5, 15, 23–26].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [5] Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol. 2000;39(1):57–106. source

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    • cites [15] Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S41–62. source

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    • cites [23] Rawlings AV. Ethnic skin types: are there differences in skin structure and function?1. Int J Cosmet Sci. 2006;28(2):79–93. source

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    • cites [24] Alaluf S, Atkins D, Barrett K, Blount M, Carter N, Heath A. Ethnic variation in melanin content and composition in photoexposed and photoprotected human skin. Pigment Cell Res. 2002;15(2):112–8. source

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    • cites [25] Szabó G, Gerald AB, Pathak MA, Fitzpatrick TB. Racial differences in the fate of melanosomes in human epidermis. Nature. 1969;222(5198):1081–2. source

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    • cites [26] Tadokoro T, Yamaguchi Y, Batzer J, Coelho SG, Zmudzka BZ, Miller SA, et al. Mechanisms of skin tanning in different racial/ethnic groups in response to ultraviolet radiation. J Investig Dermatol. 2005;124(6):1326–32. source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    People with dark skin are less likely to experience sunburn and long-term sun outcomes, which may lower how important photoprotection seems to them.

    “individuals with dark skin are less likely to experience these outcomes, which may affect the perceived importance of practicing photoprotection.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    UV radiation stimulates AP-1, upregulates MMPs, breaks down dermal collagen and elastin, and inhibits TGF-β signaling responsible for collagen regeneration.

    “UV radiation also stimulates activator protein 1 (AP-1), which leads to the upregulation of matrix metalloproteinases (e.g., MMP1, MMP3, MMP9) and subsequent breakdown of dermal collagen and elastin [49]. UV-induced activation of AP-1 also inhibits transforming growth factor (TGF)-β signaling, which is responsible for dermal collagen regeneration [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Fisher GJ, Kang S, Varani J, Bata-Csorgo Z, Wan Y, Datta S, et al. Mechanisms of photoaging and chronological skin aging. Arch Dermatol. 2002;138(11):1462–70. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    PIH and melasma are two of the most common pigmentary disorders that disproportionately affect patients with darker skin.

    “post-inflammatory hyperpigmentation (PIH) and melasma deserve mention as two of the most common conditions in this category that disproportionately affect patients with darker skin.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [37] Kaufman BP, Aman T, Alexis AF. Postinflammatory hyperpigmentation: epidemiology, clinical presentation, pathogenesis and treatment. Am J Clin Dermatol. 2018;19(4):489–503. source

      Not checked in the free run.

    • cites [38] Halder RM, Nootheti PK. Ethnic skin disorders overview. J Am Acad Dermatol. 2003;48(6):S143–8. source

      Not checked in the free run.

    • cites [42] Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80(5):387–94.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    UVA radiation is up to 20-fold more abundant than UVB in sunlight and plays a greater role in photoaging because it reaches deep dermis, whereas UVB reaches upper dermis.

    “UVA radiation is up to 20-fold more abundant than UVB radiation in sunlight and plays a greater role in photoaging due to its ability to reach the deep dermis (whereas UVB only reaches the upper dermis) [45–48].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [45] Gilchrest BA. Photoaging. J Investig Dermatol. 2013;133:E2–6. source

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    • cites [46] Han A, Chien AL, Kang S. Photoaging. Dermatol Clin. 2014;32(3):291–9. source

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    • cites [47] Huang AH, Chien AL. Photoaging: a review of current literature. Curr Derm Rep. 2020;9(1):22–9. source

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    • cites [48] Battie C, Jitsukawa S, Bernerd F, Del Bino S, Marionnet C, Verschoore M. New insights in photoaging, UVA induced damage and skin types. Exp Dermatol. 2014;23:7–12. source

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  • May combine two claims.

    Premisecitation

    Epidermal melanin attenuates transmission of damaging radiation to deeper skin structures; UVA contributes most to photoaging and UVB to sunburn and skin cancer.

    “By absorbing, scattering, and reflecting incident light, epidermal melanin attenuates the transmittance of potentially damaging radiation to deeper skin structures; this includes UVA radiation (320–400 nm) that contributes most to photoaging and UVB radiation (280–320 nm) that contributes most to sunburn and skin cancer development [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol. 2008;84(3):539–49. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Photoaging clinical manifestations are similar to but do not completely overlap with chronologic aging; chronologic aging presents fine wrinkles, volume loss, laxity, while photoaging presents coarse wrinkles, telangiectasias, solar lentigines, mottled hyperpigmentation, and dullness.

    “Whereas chronologic aging primarily presents with fine wrinkles, soft tissue volume loss, and increased skin laxity, photoaging is more likely to present with coarse wrinkles, telangiectasias, solar lentigines, mottled hyperpigmentation, and skin dullness [46, 47].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Han A, Chien AL, Kang S. Photoaging. Dermatol Clin. 2014;32(3):291–9. source

      Not checked in the free run.

    • cites [47] Huang AH, Chien AL. Photoaging: a review of current literature. Curr Derm Rep. 2020;9(1):22–9. source

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  • May combine two claims.

    Premisecitation

    In cadaver epidermal sheets, UVA transmission through black epidermis was one-third that of white epidermis (17.5% vs 55.5%), and UVB transmission was one-quarter (7.4% vs 29.4%); black epidermis was estimated to have an SPF of 13.4, nearly four times greater than white epidermis.

    “UVA transmission through black epidermis was one-third that of white epidermis (17.5% vs. 55.5%), while UVB transmission through black epidermis was one-quarter that of white epidermis (7.4% vs. 29.4%) [29].”
    • Also stated in: § Pigmentation and Pigmentary Disorders · hedged
      “black epidermis was estimated to have an SPF of 13.4, nearly four times greater than that of white epidermis [29].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Kaidbey KH, Agin PP, Sayre RM, Kligman AM. Photoprotection by melanin—a comparison of black and Caucasian skin. J Am Acad Dermatol. 1979;1(3):249–60. source

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  • May combine two claims.

    Interpretationcitation

    Racial and ethnic disparities in skin cancer mortality often result from delayed diagnosis, which may arise from underutilization of dermatologic care and differences in clinical presentation among SOC patients.

    “Racial and ethnic disparities in skin cancer mortality often result from delayed diagnosis, which may arise from underutilization of dermatologic care [75, 76] and differences in the clinical presentation of skin cancer among SOC patients.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [75] Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30(1):53–9. source

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    • cites [76] Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. 2018;154(11):1286. source

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    • cites [16] Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748–62. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    While individuals with SOC have lower melanoma incidence, their mortality rates are disproportionately higher than White individuals.

    “While individuals with SOC have a lower incidence of melanoma, their mortality rates are disproportionately higher than those of White individuals [70–74].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [70] Qian Y, Johannet P, Sawyers A, Yu J, Osman I, Zhong J. The ongoing racial disparities in melanoma: an analysis of the surveillance, epidemiology, and end results database (1975–2016). J Am Acad Dermatol. 2021;84(6):1585–93. source

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    • cites [71] Bradford PT, Goldstein AM, Mcmaster ML, Tucker MA. Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986–2005. Arch Dermatol. 2009;145(4):427–34. source

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    • cites [72] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33. source

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    • cites [73] Zell JA, Cinar P, Mobasher M, Ziogas A, Meyskens FL, Anton-Culver H. Survival for patients with invasive cutaneous melanoma among ethnic groups: the effects of socioeconomic status and treatment. J Clin Oncol. 2008;26(1):66–75. source

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    • cites [74] Wu X-C, Eide MJ, King J, Saraiya M, Huang Y, Wiggins C, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999–2006. J Am Acad Dermatol. 2011;65(5):S26.e1-S.e13. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Between 2014 and 2018 in the US, age-adjusted melanoma incidence per 100,000 was 26.0 in Whites, 5.8 in American Indians/Alaskan Natives, 4.6 in Hispanics, 1.3 in Asian/Pacific Islanders, and 1.0 in Blacks.

    “Between 2014 and 2018 in the US, the age-adjusted incidence of melanoma per 100,000 individuals was 26.0 in Whites, 5.8 in American Indians/Alaskan Natives, 4.6 in Hispanics, 1.3 in Asian/Pacific Islanders, and 1.0 in Blacks [67].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] U.S. Cancer Statistics Working Group. U.S. cancer statistics data visualizations tool, based on 2020 submission data (1999–2018). 2021. http://www.cdc.gov/cancer/dataviz. Cited 20 Sept 2021.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies involving African American, Hispanic, and Asian participants have found prevention of skin darkening is an important motivator for photoprotection, consistent with findings that individuals in these groups are less likely to regard tanned skin as attractive.

    “Studies involving African American, Hispanic, and Asian participants have found that prevention of skin darkening is an important motivator for photoprotection [98, 99, 102], consistent with findings that individuals in these groups are less likely to regard tanned skin as attractive [94, 105, 106]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [98] Buchanan Lunsford N, Berktold J, Holman DM, Stein K, Prempeh A, Yerkes A. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and hispanic men and women. Prev Med Rep. 2018;12:203–9. source

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    • cites [99] Robinson JK, Joshi KM, Ortiz S, Kundu RV. Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psychooncology. 2011;20(3):313–20. source

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    • cites [102] Mahler HIM. Reasons for using and failing to use sunscreen: comparison among whites, Hispanics, and Asian/Pacific Islanders in Southern California. JAMA Dermatol. 2014;150(1):90. source

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  • May combine two claims.

    Premisecitation

    Compared with non-Hispanic Whites, non-Hispanic Blacks and Hispanics are more likely to wear sun protective clothing and seek shade, and rates of these behaviors have increased over the past decade; indoor tanning is relatively rare in Black and Hispanic individuals in the US and its use has been declining.

    “Compared with non-Hispanic Whites, both non-Hispanic Blacks and Hispanics are more likely to wear sun protective clothing and seek shade, and the rates of these behaviors have increased over the past decade [88].”
    • Also stated in: § Photoprotection · plain
      “As a skin cancer risk behavior, indoor tanning is relatively rare in Black and Hispanic individuals in the US and its use has been declining in recent years [88, 89].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [88] National Cancer Institute. Cancer trends progress report. 2021. https://progressreport.cancer.gov. Cited 28 Sept 2021.

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    • cites [89] Guy GP Jr, Watson M, Seidenberg AB, Hartman AM, Holman DM, Perna F. Trends in indoor tanning and its association with sunburn among US adults. J Am Acad Dermatol. 2017;76(6):1191–3. source

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  • May combine two claims.

    Premisecitation

    A recent systematic review of 13 epidemiological studies concluded that UV exposure is not a significant risk factor for melanoma development in SOC, though reviewed studies were low to moderate quality.

    “A recent systematic review of 13 epidemiological studies concluded that UV exposure is not a significant risk factor for the development of melanoma in SOC, although the authors noted that the reviewed studies were of low to moderate quality [79].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] Lopes FCPS, Sleiman MG, Sebastian K, Bogucka R, Jacobs EA, Adamson AS. UV exposure and the risk of cutaneous melanoma in skin of color. JAMA Dermatol. 2021;157(2):213. source

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  • May combine two claims.

    Interpretationreasoning

    Photoprotection may improve certain pigmentary disorders and prevent photoaging and photocarcinogenesis in SOC.

    “Photoprotection may improve certain pigmentary disorders and prevent photoaging and photocarcinogenesis in SOC”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In 2015 NHIS, 10.9% of non-Hispanic Blacks and 24.7% of Hispanics reported using sunscreen SPF 15+ always or most of the time, compared with 40.4% of non-Hispanic Whites.

    “In the 2015 US National Health and Interview Survey (NHIS), 10.9% of non-Hispanic Blacks and 24.7% of Hispanics reported using sunscreen with an SPF of 15 or higher always or most of the time for sun protection, compared with 40.4% in non-Hispanic Whites [88].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88] National Cancer Institute. Cancer trends progress report. 2021. https://progressreport.cancer.gov. Cited 28 Sept 2021.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In SEER 1986-2005, ALMs accounted for 36% of melanomas in Blacks, 18% in Asian/Pacific Islanders, 9% in Hispanic Whites, compared with 1% in non-Hispanic Whites; ALM is not thought to be associated with UV radiation and instead has been linked to mechanical stress and injury.

    “A study of the Surveillance, Epidemiology, and End Results (SEER) registry from 1986 to 2005 found that ALMs accounted for 36%, 18%, and 9% of melanomas diagnosed in Blacks, Asian/Pacific Islanders, and Hispanic Whites, respectively, compared with 1% of melanomas in non-Hispanic Whites [71].”
    • Also stated in: § Photocarcinogenesis · hedged
      “ALM is not thought to be associated with UV radiation [16, 71, 74, 79] and instead has been linked to mechanical stress and injury [81, 82].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [71] Bradford PT, Goldstein AM, Mcmaster ML, Tucker MA. Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986–2005. Arch Dermatol. 2009;145(4):427–34. source

      Not checked in the free run.

    • cites [16] Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748–62. source

      Not checked in the free run.

    • cites [81] Basurto-Lozada P, Molina-Aguilar C, Castaneda-Garcia C, Vázquez-Cruz ME, Garcia-Salinas OI, Álvarez-Cano A, et al. Acral lentiginous melanoma: Basic facts, biological characteristics and research perspectives of an understudied disease. Pigment Cell Melanoma Res. 2021;34(1):59–71. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    BCC is strongly associated with UV exposure and tends to present on the head and neck even in individuals with SOC.

    “In contrast to melanoma, BCC is strongly associated with UV exposure and tends to present on the head and neck even in individuals with SOC [16, 68, 78, 84].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [16] Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748–62. source

      Not checked in the free run.

    • cites [68] Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol. 2006;55(5):741–60. source

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    • cites [78] Hogue L, Harvey VM. Basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma in skin of color patients. Dermatol Clin. 2019;37(4):519–26. source

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  • May combine two claims.

    Premisecitation

    Acculturation to Euro-American communities is associated with greater preference for tanned skin, increased sun-seeking behaviors, and decreased sun protection in individuals of Asian descent.

    “acculturation to Euro-American communities has been associated with greater preference for tanned skin, increased sun-seeking behaviors, and decreased practice of sun protection in individuals of Asian descent [108–110].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [108] Gorell E, Lee C, Muñoz C, Chang ALS. Adoption of western culture by Californian Asian Americans. Arch Dermatol. 2009;145(5):552–6. source

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    • cites [109] Bowers JM, Hamilton JG, Wu YP, Moyer A, Hay JL. Acculturation, sun tanning behavior, and tanning attitudes among Asian college students in the Northeastern USA. Int J Behav Med. 2021. https://doi.org/10.1007/s12529-021-09993-x (Epub 4 May 2021). source

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    • cites [110] Chen H-Y, Robinson JK, Jablonski NG. A cross-cultural exploration on the psychological aspects of skin color aesthetics: implications for sun-related behavior. Transl Behav Med. 2020;10(1):234–43.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Mahler, most common reasons for failing to use sunscreen among Asian/Pacific Islanders and Hispanics included forgetting to apply it, followed by dislike of greasiness; one-third of Hispanics and over half of Asian participants noted sunscreen is too greasy.

    “Mahler found that the most common reasons for failing to use sunscreen among Asian/Pacific Islanders and Hispanics included forgetting to apply it, followed by a dislike of its greasiness; whereas one-third of Hispanics noted that sunscreen is too greasy, over half of the Asian participants in the study had this concern [102].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Mahler HIM. Reasons for using and failing to use sunscreen: comparison among whites, Hispanics, and Asian/Pacific Islanders in Southern California. JAMA Dermatol. 2014;150(1):90. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Physical sunscreens with non-micronized inorganic filters may protect against UV radiation and visible light, but thick texture and significant white hue make them impractical in darker-skinned individuals; tinted sunscreens are a potential alternative.

    “Physical sunscreens with non-micronized inorganic filters (e.g., titanium dioxide, zinc oxide) may protect against UV radiation and visible light, but the thick texture and significant white hue of many formulations (when applied at the recommended amount) make them impractical in darker-skinned individuals.”
    • Also stated in: § Recommending Photoprotection for Skin of Color · hedged
      “Tinted sunscreens, which provide protection against both UV radiation and visible light, is a potential alternative considering that different shades may be available for individuals with SOC [44].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Lyons AB, Trullas C, Kohli I, Hamzavi IH, Lim HW. Photoprotection beyond ultraviolet radiation: a review of tinted sunscreens. J Am Acad Dermatol. 2021;84(5):1393–7. source

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  • May combine two claims.

    Premisecitation

    National data in the US show racial and ethnic disparities in prevalence of vitamin D deficiency, affecting Hispanics and particularly Black individuals; prior reviews suggest sunscreen use is not associated with a significant decrease in serum vitamin D levels, but most studies to date have been conducted in light-skinned participants.

    “National data in the US have shown racial and ethnic disparities in the prevalence of vitamin D deficiency, affecting Hispanics and particularly Black individuals [132, 133].”
    • Also stated in: § Recommending Photoprotection for Skin of Color · hedged
      “Prior reviews of the literature have suggested that sunscreen use is not associated with a significant decrease in serum vitamin D levels [134–136], but most studies to date have been conducted in light-skinned participants.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [132] Ginde AA, Liu MC, Camargo CA. Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004. Arch Intern Med. 2009;169(6):626. source

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    • cites [133] US Centers for Disease Control and Prevention. Second national report on biochemical indicators of diet and nutrition in the U.S. Population 2012. Atlanta, GA: National Center for Environmental Health; 2012.

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    • cites [134] Norval M, Wulf HC. Does chronic sunscreen use reduce vitamin D production to insufficient levels? Br J Dermatol. 2009;161(4):732–6. source

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    • cites [135] Kannan S, Lim HW. Photoprotection and vitamin D: a review. Photodermatol Photoimmunol Photomed. 2014;30(2–3):137–45. source

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    • cites [136] Passeron T, Bouillon R, Callender V, Cestari T, Diepgen TL, Green AC, et al. Sunscreen photoprotection and vitamin D status. Br J Dermatol. 2019;181(5):916–31. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Sunscreens with nanosized inorganic filters or organic filters are suitable if transparent formulations are desired, but they protect against UV radiation and not visible light.

    “Patients seeking transparent formulations may consider using sunscreens with nanosized inorganic filters or organic filters, although these do not provide protection against visible light.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    Commercial clothing may have inadequate UPF, and patients should use sun-protective clothing labeled with UPF of 40 or higher to provide additional photoprotection.

    “Commercial clothing may have inadequate UV protection factor (UPF), and patients should use sun-protective clothing labeled with UPF of 40 or higher to provide additional photoprotection [125, 126].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [125] Gambichler T, Altmeyer P, Hoffmann K. Role of clothes in sun protection. Cancers of the skin. Berlin: Springer; 2002. p. 15–25.

      Not checked in the free run.

    • cites [126] Wang SQ, Balagula Y, Osterwalder U. Photoprotection: a review of the current and future technologies. Dermatol Ther. 2010;23(1):31–47. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with SOC are more likely to wear sun-protective clothing and seek shade compared with White individuals, and these behaviors should continue to be encouraged since they have been shown to be more effective at preventing sunburns than sunscreen, likely due to increased duration of sun exposure among those using sunscreen.

    “In general, patients with SOC are more likely to wear sun-protective clothing and seek shade compared with White individuals, and these photoprotection behaviors should continue to be encouraged since they have been shown to be more effective at preventing sunburns than sunscreen [127, 128], likely due to increased duration of sun exposure among those using sunscreen [129].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [127] Linos E, Keiser E, Fu T, Colditz G, Chen S, Tang JY. Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness. Cancer Causes Control. 2011;22(7):1067–71. source

      Not checked in the free run.

    • cites [128] Patel SP, Chien AL. Sun protective clothing and sun avoidance: the most critical components of photoprotection in patients with melanoma. Dermatol Surg. 2021;47(3):333–7. source

      Not checked in the free run.

    • cites [129] Autier P, Boniol M, Doré J-F. Sunscreen use and increased duration of intentional sun exposure: still a burning issue. Int J Cancer. 2007;121(1):1–5. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The National Academy of Medicine's dietary vitamin D intake recommendations were formulated assuming minimal sun exposure and take into account how skin pigmentation affects vitamin D synthesis.

    “Importantly, these recommended intake values were developed based on the assumption of little to no sun exposure and accounts for variations in vitamin D synthesis due to skin pigmentation [138].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [138] Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academy Press; 2011.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Whether appearance-based interventions are more useful than health-based ones depends on each patient's concerns and priorities.

    “their utility in comparison with health-based approaches will depend on individual patient’s concerns and priorities.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The review's findings point to distinct photoprotection considerations and challenges that need more study.

    “they highlight the unique considerations and challenges to photoprotection that need to be further examined.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In NHANES 2003-2006, Hispanics and Blacks had lower 25(OH)D levels than Whites on average, but photoprotection behaviors (shade, long sleeves, hat, sunscreen) were not associated with significant decrease in 25(OH)D in Hispanics and Blacks; sunscreen use was associated with increased 25(OH)D levels among Black participants.

    “In fact, sunscreen use was associated with increased 25(OH)D levels among Black participants [137], possibly due to increased sun exposure or insufficient application/reapplication of sunscreen.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [137] Linos E, Keiser E, Kanzler M, Sainani KL, Lee W, Vittinghoff E, et al. Sun protective behaviors and vitamin D levels in the US population: NHANES 2003–2006. Cancer Causes Control. 2012;23(1):133–40. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The review's findings cannot be generalized to every skin-of-color population or geographic region.

    “While the findings discussed in this review article are not generalizable to all SOC populations and geographic regions”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The link between sun exposure and melanoma in skin of color requires further investigation.

    “including the relationship between sun exposure and melanoma in SOC”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S2 (checkable).

    Interpretationnone given

    How individual photoprotection practices influence vitamin D levels requires further investigation.

    “as well as the extent to which individual photoprotection behaviors may affect vitamin D levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Hydrochlorothiazide is linked to drug-induced photosensitivity and a higher risk of non-melanoma skin cancer, especially squamous cell carcinoma.

    “due to its association with drug-induced photosensitivity and increased risk of developing NMSC, particularly SCC [140].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [140] US Food and Drug Administration. FDA approves label changes to hydrochlorothiazide to describe small risk of non-melanoma skin cancer. 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-label-changes-hydrochlorothiazide-describe-small-risk-non-melanoma-skin-cancer. Cited 14 Sept 2020.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Counseling is the essential component for patients with skin of color.

    “counseling remains the critical piece in SOC patients [146, 147]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [146] Pourciau CY, Eide MJ, Mahan M, Lim HW. Photoprotection counseling of non-white ethno-racial groups: a survey of the practice of expert dermatologists. Photodermatol Photoimmunol Photomed. 2012;28(6):335–7. source

      Not checked in the free run.

    • cites [147] Kumar P, Kim N. Age-based gaps between awareness of photoaging and photoprotective practices among African American adults. Photodermatol Photoimmunol Photomed. 2021;37(5):428–30. source

      Not checked in the free run.

35 of 35

  • The paper relies on this without support.

    Maintaining a UV exposure level that safely supports vitamin D synthesis in patients is difficult and impractical.

    “due to the difficulty and impracticality of maintaining a safe level of UV exposure for vitamin D synthesis among patients.”

  • The paper relies on this without support.

    Dyspigmentation, photoaging, and basal cell carcinoma are well-established consequences of sun exposure in skin of color.

    “along with the well-established consequences of sun exposure in SOC, such as dyspigmentation, photoaging, and BCC.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Darker skin individuals have a decreased risk of sunburns, photocarcinogenesis, and photoaging as compared to lighter skin individuals.

    “Furthermore, even though darker skin individuals have a decreased risk of sunburns, photocarcinogenesis, and photoaging as compared to lighter skin individuals according to research studies, a multi-modal photoprotection approach is recommended for all skin types including darker skin groups to prevent these complications [67].”

    From A Comprehensive Review of the Role of UV Radiation in Photoaging Processes Between Different Types of Skin (2025) · cites this paper as [67]

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academy Press; 2011.

Cited by

Sorted by citations

Related

Authors
Tsai, J., & Chien, A. L.
Affiliations
Johns Hopkins University (US)
Corresponding author
Chien, Anna L.
ORCID
Venue
American Journal of Clinical Dermatology
Publisher
Springer Science and Business Media LLC
Published
2022-01-19
Volume
23
Issue
2
Pages
195-205
ISSN
  • 1175-0561 (ISSN-L)
  • 1179-1888
DOI
10.1007/s40257-021-00670-z
PMC
PMC8766623
OpenAlex
W4206755188
Cited by
63
References
140
Citations by year
2026: 17 · 2025: 17 · 2024: 15 · 2023: 9 · 2022: 5
FWCI
2.05
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Dermatology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Dermatology › Skin Protection and Aging
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › melanin and skin pigmentation
  • Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
Keywords
photoprotection, skin of color, sunscreen use, sun-protective clothing, ultraviolet radiation, sunburn, photoaging, basal cell carcinoma, skin cancer prevention, indoor tanning, acculturation, skin pigmentation
MeSH terms
Ethnic and Racial Minorities, Humans, Skin, Skin Pigmentation, Sunburn, Sunscreening Agents, Ultraviolet Rays

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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