Dear Editor:

Sun exposure produces a variety of adverse cutaneous conditions,including sunburn-like erythema,photosensitivity,and phototoxicity.Long-term events include photoaging and carcinogenesis.Developed countries,e.g.Britain and United States,have developed sunprotection education in the 1980s with remarkable results[1-2].We found several researches investigating the sun-protection knowledge and strategies in China such as Beijing[3].However,knowledge investigation of sun protection in Chinese dermatologists is lack,while dermatologists play a significant role to provide professional suggestions for the public towards protection from sun exposure.Herein we conducted this nation-wide,questionnaire-based survey to investigate the sun protection knowledge in Chinese derma-tologists.

A questionnaire consisted of ten types of 51 questions including demographic information,sun-protection perceptions and practices was distributed to dermatologists accompanied by two journals:Chinese Journal ofDermatologyandInternationalJournalof Dermatology and Venereologyin February,2015.The responses to the questions on sun-protective perceptions(Q1-Q5)and sun-protection practices(Q6-Q10)are shown inTable 1.

We distributed 10,000 questionnaires and received 714 answers with a response rate of 7.14%.Of these responders,the average age was 38 years(ranging from 22 to 82 years),41.6%(297/714)were male,and 58.4%(417/714)were female.Thirty-six percent of responders(257/714)were senior doctors including chief dermatologists and associate chief dermatologists,34.9% (249/714)were attending dermatologists,and 29.1%(208/714)were junior doctors including residents and trainees.Thirty-six percent of the responders(257/714)were working in a regional hospital,34.0%(243/714)were working in a district hospital,and 30.0%(214/714)were working in a community hospital.

By this survey,we found that the correct rate of questions regarding photo-aggravated diseases ranged from 10.2%to 75.9%in dermatologists.Two common photoaggravated diseases including photosensitive psoriasis and acne can’t be correctly regarded.Photosensitive psoriasis,which is a subtype of psoriasis and experiences exacerbation with UV exposure,is estimated to 5.5%of psoriasis,while the proportion of respondents to recognize the photosensitive psoriasis is only 14.1%in our investigation.It is generally accepted that irradiation of UVB induces sebaceous gland hyperplasia and increased sebum secretion[4],but only 24.1%of respondents chose acne as a photoaggravated disorder.

The correct rate of questions regarding photosensitive or phototoxic drugs ranged from 10.2%to 61.9%.This data declared that part of Chinese dermatologists did not have comprehensive knowledge towards photosensitive or phototoxic drugs,which can help dermatologists identify drug-induced photosensitive disorders,directly influence the efficacy of medication and the compliance of patients.

Over 50%of respondents made a wrong answer toward the sunscreen application dosage to get the expected SPF value,which is an usual index used in the effective evaulation of the sunscreen.As to get the expected SPF value,the standard amount of UV protective sunscreen is 2.0 mg/cm2on Asian skin as recommended by US Food and Drug Administration[5].However,the amount of sunscreen applied in real life was(0.5-1.5)mg/cm2.From the questionnaire,we found that only 9.5% of Chinese dermatologists recommend their patients to use sun-protection products,the proportion of dermatologists using sunscreen in winter was about 50%of those in summer,the proportion of Chinese dermatologists who never suggest patients to use sun-protection products is 9.5%，and the practice may be much likely to be influenced by the perceptions toward sunprotection above.

Table 1 Survery on sun-protection perceptions and practices

This study had a relatively low response rate,which may reflect a personal interest of sun protection among respondents.This may considerably undermine the generalizability of our results to Chinese dermatologists.Despite this,our findings support the need for the further education among the dermatologists about sun protective perception and sun protection behaviors so as to decline the occurrence rate of adverse cutaneous events induced or aggravated by sun exposure.

The authors would like to acknowledge the professor Wei Lai and Xue-Tong Wang for valuable suggestions on the design of questionnaire.

Yours

Yan Teng1,Wei Hou1,Yi Liu1,Baoxi Wang2*

1Hospital for Skin Diseases(Institute of Dermatology),Chinese Academy of Medical Sciences and Peking Union Medical Colleges,Nanjing,Jiangsu 210024,China.

2Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical Colleges,Beijing 100144,China.

*Corresponding author:Prof.Baoxi Wang,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical Colleges,Beijing 100144,China.Email:wangbx@ncstdlc.org.