Meet Patients Where They Are: A Dermatologist's Approach to Sun Protection Counseling

As Skin Cancer Awareness Month brings sun protection into the spotlight, Maryanne Makredes Senna, MD, a board-certified dermatologist and hair loss specialist at Lahey Hospital and Medical Center in Burlington, Massachusetts, and assistant professor of dermatology at Harvard Medical School, is focused on 2 conversations she finds herself returning to with patients, one clinical and one behavioral.

Mineral vs Chemical Sunscreen In Patients With FFA

For Senna's large population of patients with frontal fibrosing alopecia (FFA), sunscreen recommendations carry an added layer of nuance. While the relationship between chemical sunscreen use and FFA is still to be determined, she errs on the side of caution for the time being.

"I recommend that they use mineral sunscreens rather than chemical sunscreens for now until we figure that out definitively, but I encourage all patients to use sunscreens," she said.

The recommendation reflects a precautionary stance amid an ongoing clinical debate related to sunscreen use and effects on FFA—one Senna acknowledges is not yet settled. Still, she views the distinction as worth making, particularly for a patient population already navigating a progressive and often distressing condition.1

Meeting Patients Where They Are

Perhaps more urgently, Senna is thinking about the patients who do not follow sun protection advice, and what happens when clinicians respond with judgment rather than curiosity.

"My biggest concern is that there's a patient out there who loves the sun... but because every time they come in, we're reprimanding them... they just stop coming to us," she said. "That's the biggest disservice I think we can do to our patients."

Rather than repeating warnings that have not changed behavior, Senna advocates for a more exploratory approach: asking patients why they resist sunscreen, identifying specific barriers, and offering practical alternatives. She notes the field now has a wide range of elegant formulations that may address concerns around texture, finish, or cosmetic elegance.

"There's a lot of elegant, different sunscreen formulations now that we can provide to patients," she said.

Critically, Senna argues that if behavior change still does not occur, the priority must shift to keeping those patients engaged in care, because the patients who skip sun protection and skip their dermatology visits represent the highest-risk group of all.

"Those are at times our highest risk patients," she said. "The ones that don't practice sun protection, get the sunburns, get the tans... and then aren't coming in to see us."

Her message for clinicians this Skin Cancer Awareness Month is one of balance: educate consistently, remove barriers where possible, but never let the pursuit of perfect sun behavior cost a patient their access to screening and early detection.

Reference

1. Robinson G, McMichael A, Wang SQ, Lim HW. Sunscreen and frontal fibrosing alopecia: a review. J Am Acad Dermatol. 2020;82(3):723-728. doi:10.1016/j.jaad.2019.09.085