Sunscreen Product Performance and Other Determinants of Consumer Preferences

IMPORTANCE: Sunscreen use is a modifiable behavior that can help reduce the risk for skin cancer, prevent sunburns, mitigate photoaging, and treat photosensitive dermatoses. A better understanding of consumer sunscreen preferences would inform dermatologists in their own recommendations. OBJECTIVE: To determine the characteristics and the most commonly cited positive and negative features of highly rated sunscreens described by consumers. DESIGN, SETTING, AND PARTICIPANTS: The top 1 percentile of sunscreen products on Amazon. com as of December 2015 was selected according to average consumer review (≥4 stars) and the highest number of consumer reviews. Descriptive data for each product were collected from the product page and manufacturer claims. The top 5 "most helpful" reviews (positive and critical) were analyzed and coded by a consensus qualitative coding scheme, which included positive and negative descriptors in 6 major categories according to consumer comments: affordability, cosmetic elegance, separate ratings, product ingredients, product performance, and skin compatibility. MAIN OUTCOMES AND MEASURES: The Kruskal-Wallis test was performed to determine whether characteristics of each product (eg, American Academy of Dermatology AAD criteria, sun protection factor SPF, or vehicle) could be used to predict price per ounce. The number (percentage) of comments categorized by major themes and subthemes was determined. Illustrative consumer comments were also collected. RESULTS: There were 6500 products categorized as sunscreens in the Amazon. com, online catalog. Of the 65 products evaluated, the median price per ounce was 3. 32 (range, 0. 68-23. 47). Of products, 40% (26 of 65) did not adhere to AAD guidelines (broad spectrum, SPF ≥30, and water resistant) for sunscreens. Vehicles, AAD, and sunscreen type predicted a higher price per ounce. Cosmetic elegance was the most cited positive feature (198 of 325 61% comments) followed by product performance (146 of 325 45% comments) and skin type compatibility (78 of 325 24% comments). CONCLUSIONS AND RELEVANCE: In this cohort of highly rated sunscreen products, a significant proportion did not adhere to AAD guidelines, mostly attributable to a lack of water resistance. The most striking variation in this cohort was price, which varied by more than 3000%. Dermatologists should balance the importance of cosmetic elegance, cost, and AAD guidelines for sun protection in making their recommendations to consumers.