How Dermatologists Tailor Sun Protection Advice for Every Skin Concern
Why this matters
May is Skin Cancer Awareness Month, a good time to think about sun protection. But for some people the conversation is more complicated than “wear sunscreen.” Maryanne Makredes Senna, MD, a board-certified dermatologist and hair loss specialist at Lahey Hospital and Medical Center and an assistant professor at Harvard Medical School, highlights two issues she talks about with patients again and again. One is a clinical question about sunscreens and a specific kind of hair loss. The other is how doctors talk to patients who avoid sun protection.
Mineral versus chemical sunscreen and frontal fibrosing alopecia
Some of Dr. Senna’s patients have a condition called frontal fibrosing alopecia or FFA. FFA is a type of scarring hair loss that usually affects the front hairline. It is progressive, can be distressing, and makes sunscreen choices feel more urgent for those affected.
The link between sunscreen use and FFA is not settled. Research is ongoing and scientists have not reached a clear conclusion. Because of this uncertainty, Dr. Senna takes a cautious approach. She recommends that patients with FFA consider using mineral sunscreens for now. Mineral sunscreens typically contain zinc oxide or titanium dioxide and work by sitting on top of the skin to reflect UV rays. This suggestion is made out of an abundance of caution and not because there is firm proof one way or the other. (Source: Maryanne Makredes Senna, MD, interview; see also the review by Robinson and colleagues.)
Despite the uncertainty, Dr. Senna still urges all patients to use some form of sun protection. The exact type of sunscreen can be discussed with a dermatologist, especially for people with FFA or other skin concerns. (Source: Maryanne Makredes Senna, MD, interview)
Meeting patients where they are
Beyond the technical question about sunscreen ingredients, Dr. Senna worries about how clinicians respond when patients do not follow sun protection advice. She has seen people who love being outdoors stop coming to appointments because they felt judged or reprimanded each time they were asked about sunscreen use.
Her view is simple. Repeating warnings that do not change behavior can push people away. Instead, ask why a person is not using sunscreen. Find out if the problem is the smell, the greasy feel, the white cast, cost, or something else. Once you know the barrier, you can suggest practical alternatives.
There are many different sunscreen formulas available today. Some feel lightweight, some are tinted to avoid a white cast, and some are specifically designed for sensitive or oily skin. Offering options that fit a person’s preferences can make a real difference.
If someone still does not change their behavior, Dr. Senna says the most important goal is to keep them in care. People who do not protect their skin and who skip follow-up appointments are at higher risk of missing early signs of skin problems. Losing contact with these patients can be more harmful than continuing to encourage better sun habits. (Source: Maryanne Makredes Senna, MD, interview)
What this means for you
If you are worried about sunscreen and hair loss, talk with your dermatologist. If you have FFA or another skin condition, ask whether a mineral sunscreen might be recommended for now. If you dislike sunscreen, be honest about what you do not like so your clinician can suggest alternatives that feel better for you.
Tracking visible changes
If you notice changes in your skin or hair, it can help to keep a simple record. Take photos over time and note when a change started. This can make it easier to describe the issue at your appointment and help your dermatologist see whether something is getting better or worse.
When to see a doctor
Make an appointment if you notice new or changing hair loss at the hairline, new or changing skin spots, wounds that do not heal, bleeding, pain, signs of infection, or anything that feels concerning. Early evaluation helps with diagnosis and treatment options.
Disclaimer
This article summarizes a conversation with a dermatologist and a related review paper. It is for general information and does not replace personalized medical advice. Treatment decisions should be discussed with your doctor or dermatologist.
Sources
- Maryanne Makredes Senna, MD. Interview. (Source: Maryanne Makredes Senna, MD, interview)
- Robinson G, McMichael A, Wang SQ, Lim HW. Sunscreen and frontal fibrosing alopecia: a review. 2019. doi:10.1016/j.jaad.2019.09.085 (Source: Robinson G, McMichael A, Wang SQ, Lim HW. Sunscreen and frontal fibrosing alopecia: a review.)