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Farberg AS, Glazer AM, Rigel AC, White R, Rigel DS. Dermatologists’ Perceptions, Recommendations, and Use of Sunscreen. JAMA Dermatol. 2017;153(1):99–101. doi:10.1001/jamadermatol.2016.3698
Regular use of sunscreen is an important component of sun protection and has been shown to reduce the risk of skin cancer.1 Multiple professional organizations, including the American Academy of Dermatology, as well as dermatologists themselves, have recommended patient counseling regarding the use of sunscreen.2,3 However, there have been other conflicting messages about sunscreen (sometimes without scientific support) that have led to confusion by the public.4 Dermatologists regularly discuss these issues with patients and their recommendations affect patients’ selection of sunscreen; however, to our knowledge, their actual views have not been studied.2,5 The purpose of this study was to determine, via a survey, US dermatologists’ perceptions of the safety and efficacy of sunscreen, recommendations to patients regarding its use, and their personal use of sunscreen (Figure).
The survey instrument was validated and administered to US dermatologists attending a national educational conference on April 9, 2016. Respondents provided answers using a live interactive audience response system. Group results were not revealed until completion of the survey to minimize response bias. To verify the representative nature of the responding subset, respondent demographics were compared with membership data from the American Academy of Dermatology. Comparative data were analyzed using standard χ2 tests. The institutional review board at NYU School of Medicine waived approval of this study. All participants provided verbal consent.
Of the 165 US dermatologists offered the survey, 156 (94.5%) participated and completed enough of the questions (26 of 28 [92.9%]) to be included in the outcome analyses. Dermatologists have an overall positive view of sunscreen: 97% agree that regular use of sunscreen helps lower the risk of skin cancer, 100% agree that use of sunscreen reduces subsequent photoaging, and 99% recommend that their family and friends use sunscreen (Table). Nearly all dermatologists (96%) consider sunscreens approved by the US Food and Drug Administration (FDA) that are currently available in the United States to be safe. Ninety-nine percent of dermatologists believe that their patients generally do not apply enough sunscreen.
Sunscreens with a higher sun protection factor (SPF) are more protective when used at real-world application concentrations. Ninety-seven percent of dermatologists said they were comfortable recommending sunscreens with an SPF of 50 or higher and 130 (83.3%) believe that high-SPF sunscreens provide an additional margin of safety. Most dermatologists believe that oxybenzone and retinyl palmitate in sunscreens are safe (91% and 87% respectively). Dermatologists used multiple criteria to recommend sunscreen, including SPF level (99%), broad-spectrum protection (96%), cosmetic elegance and/or feel (71%), and photostability (42%). For outdoor use, 100% of dermatologists choose a sunscreen with an SPF of at least 30 for themselves and 76% typically wear sunscreen more than half the time. There were no significant differences based on respondents’ geographical location or years in practice.
This study found that nearly all dermatologists agree that sunscreens approved by the FDA are safe in protecting against skin cancer and photoaging and recommend broad-spectrum protection with sunscreen with an SPF of at least 30. Dermatologists themselves often report using suncreen with an SPF of 50 or more, possibly because they also believe it provides an additional margin of safety. However, only 42% of dermatologists consider photostability a criterion when recommending a sunscreen. Given the importance of photostability as a sunscreen characteristic, this finding may represent a knowledge gap and corresponding educational opportunity for both physicians and patients.
The FDA and the American Academy of Dermatology have published guidelines to help consumers select and use sunscreens appropriately.3 A recent study suggests that these guidelines may not have been effectively disseminated.6 In addition, nonphysician groups have produced varying and contrary public recommendations about the use of sunscreen.4 In some cases, these recommendations have led to confusion among the public, as people often choose not to heed any recommendations until consensus is achieved.
A limitation of this study includes selection bias, as dermatologists who have stronger beliefs about sun protection may have been more likely to respond. In addition, social desirability bias may have been a factor, leading the dermatologists to provide more positive than negative answers.
As debate continues about optimizing the use of sunscreen, it is important to assess and understand dermatologists’ views as well as the recommendations they provide to patients. This study provides insights into these issues and has identified potential knowledge gaps and corresponding educational opportunities where existing recommendations can be reviewed to better align with actual dermatologic practices.
Accepted for Publication: August 12, 2016.
Corresponding Author: Aaron S. Farberg, MD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 35 E 35th St, Ste 208, New York, NY 10016 (firstname.lastname@example.org).
Published Online: October 19, 2016. doi:10.1001/jamadermatol.2016.3698
Author Contributions: Drs Farberg and D. Rigel had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Farberg, D. Rigel.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Farberg, Glazer, D. Rigel.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Farberg, A. Rigel.
Administrative, technical, or material support: Farberg, Glazer, White.
Study supervision: Farberg, D. Rigel.
Conflict of Interest Disclosures: Drs Farberg and D. Rigel reported serving as consultants for Johnson & Johnson. No other disclosures were reported.
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