Abstract
Application of sunscreen is a widely used mechanism for protecting skin from the harmful effects of UV light. However, protection can only be achieved through effective application, and areas that are routinely missed are likely at increased risk of UV damage. Here we sought to determine if specific areas of the face are missed during routine sunscreen application, and whether provision of public health information is sufficient to improve coverage. To investigate this, 57 participants were imaged with a UV sensitive camera before and after sunscreen application: first visit; minimal pre-instruction, second visit; provided with a public health information statement. Images were scored using a custom automated image analysis process designed to identify areas of high UV reflectance, i.e. missed during sunscreen application, and analysed for 5% significance. Analyses revealed eyelid and periorbital regions to be disproportionately missed during routine sunscreen application (median 14% missed in eyelid region vs 7% in rest of face, p<0.01). Provision of health information caused a significant improvement in coverage to eyelid areas in general however, the medial canthal area was still frequently missed. These data reveal that a public health announcement-type intervention could be effective at improving coverage of high risk areas of the face, however high risk areas are likely to remain unprotected therefore other mechanisms of sun protection should be widely promoted such as UV blocking sunglasses.
Highlights
Despite increasing sun awareness and sun protection usage, between 70–90 percent of basal cell carcinomas (BCCs) develop in sun-exposed head and neck regions, and 5 to 10 percent of all skin cancers occur on the eyelids alone[1]
Eyelid regions and medial canthal areas are disproportionately missed during routine sunscreen application
UV light is absorbed by melanin and sunscreen, so areas of high pigment or sunscreen coverage appear darker in these photographs whereas non-pigmented skin areas or without sunscreen appear lighter [30]
Summary
Despite increasing sun awareness and sun protection usage, between 70–90 percent of basal cell carcinomas (BCCs) develop in sun-exposed head and neck regions, and 5 to 10 percent of all skin cancers occur on the eyelids alone[1]. Use of sunscreens for sun protection requires two conditions to be met: i) adequate quantities of the substance to be applied with appropriate frequency of reapplication, and ii) effective coverage of all sun exposed areas. The majority of sunscreen application publications use surrogates in place of real sun creams to determine coverage. Often these surrogates are of different texture or visibility which may influence application [27,28]. We have adopted the UV imaging approach to determine if skin cancer prone facial regions are ineffectively covered, and if an information based intervention could be used to improve sunscreen application
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