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Where did the SPF knowledge gap begin?

Do Black people need sunscreen? Plug this question into Google and you get over 70 million results that all emphasize a resounding yes.

And yet the conversation of how necessary this preventive practice is has been disregarded — and sometimes by the Black community — for years.

Leah Donnella wrote for NPR’s ‘Code Switch,’ “I never really worried about protecting my skin from the sun. ‘Black don’t crack’ wasn’t a phrase I really heard a lot growing up. If anything, it was ‘black don’t burn.’”

However, this lack of awareness isn’t a myth that comes from the Black community itself. It starts with the medical community.

Historically, the field of medicine hasn’t given Black people adequate medical care, and the field of dermatology is no exception.

Dr. Chesahna Kindred, vice chair of the National Medical Association dermatology section, agrees that there’s a difference in attention given to Black skin within the practice.

She tells Healthline, “[A lot of the] funding and awareness [for research on the effect of the sun] typically excludes those with darker skin tones.”

And data backs up this disparity: A 2012 study found that 47 percent of dermatologists and dermatology residents admitted that they weren’t properly trained on skin conditions in Black people.

A 2014 study found that Black people were prescribed sunscreen after ER visits roughly 9 times less than their white counterparts.

Even in cases of pigment-related skin diseases where sun sensitivity is a concern, doctors still tell Black people to use sunscreen much less than their white counterparts.

Another study found that in the case of dyschromia, a skin pigmentation disorder, Black individuals were less likely to receive combination therapy compared to other skin types.

And to follow up with the research that both patients and physicians believe in sun immunity, 2011 research found that in comparison to white patients, dermatological clinicianswere often less suspicious about sun lesions and other causes for alarm in Black patients.

When it comes to skin cancer, decreasing the risk is just as important as decreasing the degree to which people die from it.

Research suggests that many patients and physicians believe that non-white people are “immune” to common skin cancers. They aren’t. This myth may have come from the statistic that the Black community has a lower incidence of skin cancer.

However, what’s left out of the conversation is: Black folks who do develop skin cancer may be more likely to receive a late-stage prognosis.

Squamous cell carcinoma is a common type of cancer that develops on skin that has received prolonged exposure to the sun. According to the American Academy of Dermatology, in the United States alone, there are about 700,000 new diagnosis each year.

Despite being the second most common skin cancer, squamous cell carcinoma of the skin is usually curable when caught early.

Although skin cancer is less prevalent in the black community than in the white population, when it does occur among people of color, it tends to be diagnosed at a later, and more advanced, stage.

Studies show that black people are four times more likely to be diagnosed with advanced stage melanoma and tend to succumb at a rate of 1.5 times more than white people with a similar diagnosis.

Another contributor to this statistic could be instances of acral lentiginous melanoma (ALM), a type of melanoma commonly diagnosed in the black community.

It forms in areas not exposed to the sun: the palms of the hands, the soles of feet, and even underneath nails. Though not related to sun exposure, the areas where the cancer tends to form, no doubt has a hand in the often-delayed prognosis.

Dr. Candrice Heath, a board-certified dermatologist, wants her Black clients to know: “Get your skin checked, you are not immune to skin cancer. You don’t want to die from something that is preventable.”

“Black patients carry the burden of diseases that are sun sensitive”
— Dr. Kindred
High blood pressure and lupus are two examples of diseases that are very over-represented in the Black community. Lupus directly increases the skin’s sensitivity to light, while certain medications and treatments for high blood pressure increase skin’s sensitivity to light. Both increase the risk of harmful UV damage.

We all know about the magic of melanin. According to Dr. Meena Singh of the Kansas Medical Clinic, “patients with darker skin tones have a natural SPF of 13” — but when it comes to the sun’s damaging effects, the power of melanin is hugely overstated.

For one, the natural SPF of 13 that some Black people have in their skin is a lot less than the daily use of a SPF 30 or higher that dermatologists recommend for sun protection.

Dr. Singh also adds that the melanin in darker skin can only “protect from some of that [UV] damage.” Melanin may not be able to protect the skin from UVA rays as well as it protects skin from UVB rays.

Melanin is also not consistent throughout the body

Another common concern related to sunscreen use is how it affects the body’s absorption of vitamin D. Vitamin D deficiency may be approximately twice as prevalent in the Black population as it is in the white population, and many people believe sunscreen exacerbates this.

Dr. Heath adds that this myth is unfounded.

“When it comes to vitamin D, even when you wear sunscreen, you are still getting an adequate amount of sunlight to aid with vitamin D conversion.” Sunscreen still lets in the good stuff — like vitamin D from the sun — it just blocks the dangerous UV radiation.

Fortunately, there’s a changing tide to make skin care more knowledgeable and inclusive for Black skin.

Dermatology organizations such as the Skin of Color Society are actively working to give research grants to dermatologists to study Black skin.

According to Dr. Singh, “There has been an enhanced focus on sun protection within the academic dermatology realm, as well as increasing specialized knowledge about treating skin of color, while also increasing the number of Black dermatologists.”

More companies are also becoming attuned to the needs of Black people.

As Dr. Kelly Cha, Michigan Medicine dermatologist, pointed out in a 2018 article, much of the advertising and packaging of sunscreen and sun protection has been geared toward non-Black people.

That marketing strategy may have helped increase the idea that sun care wasn’t important in the Black community.

“Mineral-based sunscreens can leave a white film on darker skin,” Dr. Singh says, “which often can be seen as cosmetically unacceptable.”

The ashy result also signals that the product was created with the intention of being applied on paler skin, which can blend in easier with white casts.

Now companies such as Black Girl Sunscreen and Bolden Sunscreen are changing the landscape and making sun care more accessible — designed with darker skin in mind. These brands specifically focus on creating sunscreens that don’t cast ashy shadows.

“Skin care lines now understand that products that are branded specifically toward black customers are not only lucrative, but also well-received,” says Dr. Singh.

“[With] the advent of social media [and] more of an emphasis on self-care, patients themselves are helping to advocate for these products.”

Health disparities in the Black community are well-known. From the pregnancy inequalities that have plagued Black women, including high-profile women like Serena Williams, to the high proportion of obesity in the Black community highlighted by women like Michelle Obama.

We shouldn’t leave sun protection and awareness out of these conversations, especially when it comes to preventing squamous cell carcinoma. Sunscreen is helps keep the melanin magical and the skin healthy.

Tiffany Onyejiaka is a graduate of Johns Hopkins University where she majored in public health, Africana studies, and natural sciences. Tiffany is interested in writing and exploring the way health and society connect, particularly with how health affects this country’s most disempowered populations. She’s passionate about increasing health awareness and education for people from all different demographics.]