The Fitzpatrick scale is the tool commonly used by dermatologists to differentiate between different skin types based on the effect of ultraviolet radiation (UVR) on their skin. It ranges from type 1, pale skin, burns very easily and doesn’t tan, to type 6, dark brown skin with dark brown eyes and black hair, in which the skin rarely, if ever, burns. When talking about skin of colour there is no concrete definition, however, in this context we will be referring to Fitzpatrick types 5 and 6. Broadly speaking, this group encompasses people of diverse geographic ancestral origin, including some people of African, Caribbean, South American, and Indian sub-continent, as well as people of mixed ancestry.

Skin cells called melanocytes produce melanin, the pigment that gives our skin colour. The colour of our skin primarily depends on the amount of melanin that is produced. Different ethnic groups vary as to the amount of melanin they produce based on their genes, resulting in a variety of different skin tones, with those producing more melanin having darker skin tones. Exposure to sunlight can cause our skin to become darker than usual as the melanocytes produce more melanin in attempt to protect against further UVR – this is a tan, and is a sign of your skin reacting to sun damage.

To a degree, yes. Naturally occurring biological agents in the skin absorb a proportion of UVR, with melanin being one of these. People with the darkest brown skin, for example those of African descent, have the most melanin and so are usually best protected from the sun.

Just because your skin may have some natural protection from the sun’s UV rays, it doesn’t mean you are completely resistant to sun damage. When we talk about sun damage we are talking about four types of damage: sunburn, skin ageing, hyperpigmentation and skin cancer.

Sunburn: Sunburn is mainly caused by UVB rays from the sun. Sunburn is unlikely amongst people with naturally brown, and especially dark brown, skin, although it can happen. Indeed, sunburn in people with very dark brown skin is so rare in UK sunshine that if it does happen, you may wish to seek medical advice as it is possible that your skin is abnormally sensitive to sunlight.

Skin ageing: Sun exposure is the primary environmental cause of skin ageing. Although the natural protection offered by brown and dark brown skin types does also seem to provide some protection against photoageing, it does not necessarily prevent it over the longer term and naturally dark brown skin that receives a lot of sun exposure can still show the signs of sun-induced ageing later in life.

Hyperpigmentation: Hyperpigmentation, spots or patches of darker skin, can be caused by a range of conditions or injuries, including acne, melasma, and sun damage. Hyperpigmentation is particularly common amongst people of colour. Sun exposure can cause these areas to become more pronounced as the body produces more melanin. Using sun protection may help maintain a more uniform skin tone.

Skin cancer: This is rare in people with skin types 5 and 6, however, when it does occur it tends to be detected later, at a more advanced stage, and therefore is more dangerous. Reports have shown that paler-skinned women and men are 20 and 32 times more likely to develop malignant melanoma (a form of skin cancer) than women of colour and men of colour respectively. Additionally, whilst skin cancer rates amongst the Caucasian population continue to rise, skin cancer rates in populations of people of colour remain stable. In people of colour, melanoma may be more difficult to detect, and also people may not report it early, as they may mistakenly believe that skin cancer cannot occur in their skin type. When it comes to detecting skin cancer you should be looking for lesions or spots, either new or old, which are changing, be it in size, shape, or colour, and keep an eye out for wounds or ulcers that won’t heal. It is advised that you check your skin regularly, with particular focus on your palms, soles, nails, genital regions, and mucous membranes. The mucous membranes are the moist surfaces of the body such as the surface layers of the eyes, the inside of the nose, the throat, and the genitalia. If in doubt speak to your GP about your concerns.

There is very good evidence that vitamin D is needed to keep bones and muscles healthy. It has also been suggested that vitamin D may help to prevent other serious diseases such as cancer, various forms of arthritis and autoimmune diseases. People with pale skin, who are more at risk of skin cancer, have to carefully balance the benefits and risks of sun exposure. For people of colour there is a much lower risk of skin cancer, and a much higher risk of vitamin D deficiency, and as such, people of colour are more likely to benefit from sun exposure. Research shows that sun exposure in the UK can help people of colour avoid vitamin D deficiency in the summer months. Relatively short periods of around 25 minutes with head, arms and legs exposed, on most days of the week, can help to obtain this in summertime. However, to reach higher levels, known as vitamin D sufficiency, and to maintain levels year-round, requires supplements of vitamin D taken by mouth. Overall, vitamin D supplements are recommended for people of colour, but sun exposure alone may suffice during the summer months, and it can help boost levels. Vitamin D supplements year-round are also an appropriate approach. In the UK, 10 micrograms (400 IU) daily has been recommended for adults although around twice that daily dose can be safely taken (800-1000 IU). In children less than 1 year old, 8.5 micrograms daily is recommended (SACN 2016).

In the UK, sun protection to avoid sunburn is probably unnecessary in people of colour, especially those with very dark brown skin. This is because people with dark brown skin are about eight times less sensitive than people with white skin in terms of sunburn or damage to skin cells, while in comparison people with brown skin are about four times less sensitive than those with white skin. In the UK, the maximum UV Index – a measure of the sunburning power of the sun – is about seven, and sun protection is generally recommended when the UV Index is higher than three. So a UV Index of seven on white skin is equivalent to a UV Index of less than one on dark brown skin – well below the threshold when sun protection is recommended. Indeed, using sun protection may be detrimental to your health as it can limit the production of vitamin D in your skin (see above). However, there is an important exception to this advice. Sun protection is important if you have a skin condition, such as photosensitivity, vitiligo or lupus, or have a high risk of skin cancer, especially if you are taking immunosuppressive treatments (including organ transplant recipients) or if you are genetically pre-disposed to skin cancer. If you are abroad in countries with strong sunny climates, the UV Index can be extreme (11 or higher) and if you plan on spending a prolonged time outdoors, you may wish to consider applying sunscreen and/or wearing clothing (and a hat) to limit your sun exposure and help protect against sunburn, sun induced-ageing, or the exacerbation of hyperpigmentation.

We always recommend a three-pronged approach to sun protection: shade, clothing, sunscreen. You can protect the skin with clothing, including a hat, and make use of shade between 11am and 3pm when the sun’s UV rays are strongest. And don’t forget sunglasses as our eyes can also be damaged by too much sunlight. When it comes to choosing your sunscreen you’ll want one that has a minimum of SPF 30 and good UVA protection. To tell if your sunscreen has good UVA protection look for either a UVA logo, with the letters “UVA” printed in a circle, or with a four or five-star UVA rating indicated on the back of the sunscreen bottle. When it comes to managing hyperpigmentation, such as melasma, then clothing/hats are advisable, and physical sunscreens containing inorganic filters such as titanium dioxide, zinc or iron oxide, are preferable to other sunscreens. Unfortunately, a common concern for people with darker skin types is the white or grey residue that some sunscreens leave behind. Before buying a sunscreen it is a good idea to ask if you can try a tiny sample on your skin to see if you are happy with the cosmetic result.

Nowadays there is a vast range of different product types available, including lotions, mousses, sprays and gels. As a rule, the labelled sun protection factor (SPF) is not achieved because people generally apply less sunscreen than is used in the testing process by the manufacturers. Clearly the more generously sunscreen is applied, the higher will be the protection delivered. When applying sunscreen, spread the product smoothly and evenly over the skin surface. Don’t rub it in but allow the sunscreen to dry on the surface. It’s best to apply sunscreen before going into the sun and then again after swimming, perspiring and towel drying, or if it has rubbed off. ‘Water resistance’ is tested by the ability of a sunscreen to retain its sun protection properties following relatively short periods of time after activity in water. However, most of a product can be removed by towel drying, so you should reapply after swimming, sweating, or any other vigorous or abrasive activity. Another important factor is the reflection of the sun’s rays, which can greatly increase the amount of UVR you receive, including reflection by snow, sand and water