Darker skin needs less sun protection

GPs are being asked to give individually tailored advice that considers vitamin D and other benefits of sun exposure.

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A new position statement on balancing the harms and benefits of sun exposure has been released, with a swing towards more tailored advice based on individual risk factors for both skin damage and vitamin D deficiency.

The statement, available on the Australian Skin and Skin Cancer Research Centre’s website, has been launched with little public fanfare, with authors keen not to muddy the waters when it comes to sun-smart public health messaging.

Professor Rachel Neale from QIMR Berghofer, presenting at the Australasian Melanoma Conference in Brisbane on Friday, told delegates the major shift within the statement was for people with dark skin.

“One easy and obvious solution would be to tell everybody to stay out of the sun and meet their vitamin D requirements through supplementation,” she said.

“But there has been more and more evidence emerging of non vitamin D-related benefits of sun exposure.

“So, we need to find a balance to enable people to get what they need from the sun without increasing the risk of skin cancer, which is obviously very tricky.

“Importantly, the balance of the risks and benefits may not be the same for all people, and [until now] we’ve been delivering messages to the general public that assume that the risks are fairly similar.

“The big change is that for people with dark skin, who are at lower risk of skin cancer, but higher risk of vitamin D deficiency, sun protection is only needed if they are outdoors for more than two hours when the UV index is more than 3,” Professor Neale said.

The position statement is targeted at three groups:

People at high risk of skin cancer

“People who are at high risk of skin cancer (i.e., very pale skin and/or olive/pale brown skin but with other risk factors) are advised to adopt an extremely cautious approach to sun exposure. Where possible, time outdoors when the UV index is equal to or greater than 3 should be avoided, and when outdoors at these times a full suite of sun protection measures should be used. This may increase the risk of vitamin D deficiency. Vitamin D requirements can be met through dietary sources and/or vitamin D supplements, and the benefits of other solar wavelengths can be obtained through early morning exposure when the UV index is <3.”

People at low risk of skin cancer

“People with constitutively dark skin are at low risk of skin cancer and the dose of UV-B needed to generate vitamin D is greater, leading to higher risk of vitamin D deficiency. These people are advised to spend sufficient time outdoors with ample skin exposed when the UV index is equal to or greater than 3 to obtain a vitamin D-effective dose of UV radiation. Sun protection is not needed unless spending extended time outdoors when the UV index is equal to or greater than 3.”

People at intermediate risk of skin cancer

“There is a group of people who are at intermediate risk of skin cancer (i.e. with olive or pale brown skin and no other risk factors), for whom the risk versus benefit equation is less straightforward. For this group, sun protection is important. However, current evidence suggests it is prudent to invoke the precautionary principle and advise spending sufficient time outdoors with ample skin exposed to avoid vitamin D deficiency; that is, to obtain a vitamin D-effective dose. If spending any more than the time estimated to obtain a vitamin D-effective dose, a full suite of sun-protection behaviours is advised. Sunscreen should be applied as part of the usual daily routine on all days when the UV index is forecast to reach equal to or greater than 3; there is little evidence to suggest that this increases risk of vitamin D deficiency.”

Speaking with TMR, Professor Neale said it was hard to put that advice into population-level messaging because “we must not undermine the sun-smart messaging”.

“We need to continue to promote skin protection methods, but we’re keen for GPs to take a look at the position statement and the resources available to them for tailoring their individualised advice to a patient’s risks, depending on their skin type and where they live,” she said.

“We are developing a website that will help GPs to enter a patient’s risk factors and generate individual advice.

“At this stage we don’t want to send the public mixed messages. It is a big step to no longer recommend routine sun protection for people with dark skin.”