Rashmi Unwala. Practice Gaps—Failure to Scrutinize Actual UV-A Protection When Recommending Sunscreen-Containing Moisturizing CreamsComment on “Lack of UV-A Protection in Daily Moisturizing Creams”. Arch Dermatol. 2011;147(5):620–621. doi:10.1001/archdermatol.2011.99
The deleterious effects of UV-A radiation (UV-A) are important in many areas of dermatology, including cutaneous oncology, photoaging, and connective tissue disorders. Because a fundamental objective in caring for patients is educating them about measures that may reduce the burden of their disease, dermatologists strive to ensure that their patient education is as accurate as possible. For years, dermatologists have been educating the public about the importance of looking beyond the UV-B–specific sun protection factor. We instruct patients to select only those sunscreens and facial moisturizers that specifically state “UV-A protection” on the label. However, Wang et al note that products containing UV-A sunscreens do not necessarily contain adequate proportions or adequate coingredients to actually block UV-A when applied. The analysis of 29 daily facial moisturizers that claim to have “broad-spectrum” UV coverage identified only 10 with adequate UV-A1 protection, based on established principles of photobiology and photochemistry. The use of sunscreens that lack effective UV-A protection could result in exacerbated photoaging and increased skin cancer risk, and the use of sunscreens with different UV-A blocking capabilities provides, at best, inconsistent protection for patients with cutaneous lupus erythematosus.1
Patients rely on their dermatologists to distill the vast body of scientific knowledge and transmit the information necessary to optimize patient health in a manner that people of all health literacy levels understand.2 Many dermatology encounters include patient education about proper sun-protection measures. Wang et al identify a practice gap in translating basic scientific knowledge into a message that will allow patients to critically evaluate a manufacturer's claim. Not all UV-A sunscreen–containing products sufficiently block UV-A. Our message to patients about qualifying products should become more specific.
The major barrier to bridging the gap between understanding the optimal chemical formulation of a sunscreen with adequate UV protection and teaching the patient how to identify an appropriate sunscreen to meet their health needs is the complexity of the message. With many demands on a dermatologist's time, it is difficult to spend more time explaining this issue in the patient examination room.
To narrow this practice gap, dermatologists should critically review their patient education materials to ensure that they instruct on the latest information in a simple manner. We should ensure that we are not inadvertently undermining our message by dispensing poorly chosen samples and cosmeceuticals or by offering mixed messages in our patient-education materials (eg, pamphlets, reading material in the waiting room, and posters from multiple sources with different sun-protection messages). As specialists, dermatologists should continue to advocate for patients by working with industry to insist on ingredient concentrations that appropriately block UV-A in product formulations.
The study by Wang et al is a fresh approach to “bench to bedside” research that examines what patients are actually doing (eg, shopping on Amazon.com) and what we, as dermatologists, can do to positively influence this behavior. Future research may provide valuable guidance to patients who become lost in the vast marketplace of over-the-counter skin care products. This study also reminds us to critically evaluate our own educational materials to ensure they always reflect the latest basic scientific knowledge.
Correspondence: Dr Unwala, Department of Dermatology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449 (firstname.lastname@example.org)
Financial Disclosure: None reported.