PD16 The sunscreen dilemma in photosensitivity: navigating ultraviolet and visible light protection

Abstract Managing photosensitivity conditions, including polymorphic light eruption (PLE), chronic actinic dermatitis (CAD), solar urticaria (SU) and cutaneous porphyria, necessitates comprehensive photoprotection strategies. Sunscreens, a cornerstone of these strategies, can pose unique challenges for photosensitive individuals, who may not have an ultraviolet or visible light sensitivity that corresponds to the standard erythema curve. This can mean sunscreen effectiveness for these individuals is not adequately addressed by the product’s sun protection factor (SPF). However, if an individual has heightened visible light sensitivity, as typically seen in SU or porphyria, this does not necessarily mean a visible light-protecting sunscreen is the best choice. This was previously shown for a patient with visible light-sensitive SU who had greater effectiveness with an SPF 50+ formulation without visible light filters compared with one that did. It is thus challenging for people with photosensitivity to know how to select an appropriate sunscreen or for clinicians to advise on optimal choices. This study aimed to evaluate real-world sunscreen usage among photosensitive individuals, exploring factors involved in sunscreen choices, including the role and importance of UV and visible light protection. A structured questionnaire was developed and distributed through the Scottish Photobiology Service and the British Porphyria Association to individuals with a range of photosensitivity conditions, collecting data on sunscreen preferences, usage challenges and visible light protection awareness. There were 82 responses. Difficulties with sunscreen use were reported by 44%, with approximately half expressing dissatisfaction with certain products. Variations in adoption of visible light-protecting sunscreens were observed across conditions. For individuals with CAD, 17% used visible-protecting sunscreen and 50% did not; 33% were not ascertained (NA). For individuals with SU, only 8% used visible-protecting sunscreens and 58% did not (33% NA). With PLE, 43% used visible-protecting sunscreens and 43% did not (14% NA). For photosensitive porphyria, 56% confirmed visible-protecting sunscreen usage, while 32% did not (12% NA). Those without a clear photosensitivity diagnosis showed the lowest uptake of visible-protecting sunscreens (0%), with 65% not using them (35.3% NA). These findings highlight the complexity of sunscreen choices and usage for photosensitive individuals. Given that almost half of responders with porphyria, and > 90% of those with SU, were not using visible-protecting sunscreens, this also highlights the challenges for clinicians in recommending sunscreen choices based on diagnosis, although further detailed evaluation into the reasons behind sunscreen choices is required. Close collaboration with industry is needed to highlight the specific challenges of sunscreen choices for patients with photosensitivity diseases, with emphasis on individualized approaches as the mainstay of photoprotection.