Dermbusters: Carly Elston, MD

Do patients with skin of color need sunscreen?

First, Dr. Brownstone asks Dr. Elston how to advise patients with skin of color who believe they don’t need sunscreen. Dr. Elston references studies that show not only do patients with skin of color get skin cancer, they also tend to get diagnosed later and have higher mortality.

She details a study that examined melanoma survival among White, Hispanic, Asian, and Black women, which demonstrated that those with skin of color had lower survival rates, with Black women having the lowest.

To encourage sunscreen use among her patients with skin of color, Dr. Elston recommends products that will be more cosmetically favorable on pigmented skin; some of the physical blockers can be challenging, so she often recommends sunscreens that are in a clear- or a gel-base that will rub in.

If a topical medication isn’t burning, does that mean it’s not working?

Next, Dr. Brownstone chats with Dr. Elston on a common misperception heard from patients—if a topical medication isn’t burning, it isn’t working.

Dr. Elston explains that many medications burn or sting because of what’s in the vehicle, like lactic acid affecting patients who are sensitive to cosmetic products or propylene glycol causing an irritant effect. She explains to patients that the resulting stinging is not a result of the products’ efficacy. She also explains that other drugs cause burning because of the drug effect, for example, topical calcineurin inhibitors causing a capsaicin-like burning reaction that often gets better the longer patients use them. She helps dispel this common misconception by advising patients that these medications work just as well when the burning stops.