§ Claim under review · Efficacy
"Areas like behind the ears, the neck, and the backs of hands are commonly forgotten when applying sunscreen, despite being exposed to sun/UV radiation and needing protection." (Post images, Indonesian: "Area yang Sering Dilupakan Saat Pakai Sunscreen: 1. Belakang Telinga... 2. Leher... 3. Punggung Tangan...")
Verdict
Mostly accurate
Confidence
MediumSummary
This post says people often forget to put sunscreen behind the ears, on the neck and on the backs of the hands, and that these areas still get sun. That is mostly right. In one survey of 214 people at a beach, only about half put sunscreen on the backs of their hands. A clinic study of people who had already had a skin cancer found the ears were often under-covered, and a published review of this research lists the ears and the neck among the places people commonly miss. Dermatology bodies in the United States and the United Kingdom both tell people to include the neck, the ears and the backs of the hands. Two things are worth knowing: the research measured adults in the United States and the United Kingdom, not teenagers or people in Indonesia, and no study was found that measured the skin behind the ear specifically, so that exact detail is less well established than the general point. Also, the post is an advertisement, and evidence that people miss these spots says nothing about how well any particular sunscreen works. For parents and carers of younger readers who see posts like this, the underlying advice to cover all exposed skin is standard dermatology guidance, but the product recommendation attached to it is marketing and is not graded here. This is general information only, not medical or dermatological advice.
The readings
key figures from the evidencebeachgoers applying sunscreen to dorsal hands
males more likely than females to adequately cover ears
participants missing medial canthal region of face
Why this verdict
Evidence
Measured studies of how people actually apply sunscreen support the general proposition that head, neck and hand sites are frequently under-covered.
In a beach survey of 214 people, less than half of subjects (105, 49%) applied sunscreen to their dorsal hands, with women applying sunscreen to the dorsal hands more than men (55% of women versus 40% of men, P = 0.04) , and the authors concluded that more public education focused on dorsal hand protection from ultraviolet radiation is necessary to reduce the risk for squamous cell carcinomas of the hands .
In a clinic study of people with a history of skin cancer who were asked to apply sunscreen to the head as they normally would, coverage was scored under Wood's lamp lighting on a four-point scale, and the average coverage score was 3.27, with males 7.61 times more likely to adequately apply sunscreen to the ears (p = 0.001) . The authors' accompanying figure states that the ears are commonly missed sites when applying sunscreen, which may be a consequence of hairstyle .
A UV-photography study of facial application summarised the prior literature by noting that a number of studies have demonstrated incomplete sunscreen application on the hairline, ears, neck, and dorsal feet , and in that study itself complete absence of sunscreen coverage was most common on the lower eyelid margin (84%), upper eyelid margin (82%) and medial canthus (71%) .
The best-known quantified "missed areas" study is about the face rather than these three sites: on average people missed 9.5 per cent of the whole face, with the most commonly missed areas being the eyelids, where on average 13.5 per cent of the eyelid was missed, and the medial canthal region, which was missed by 77 per cent of participants .
Professional guidance names the same sites the post names. The AAD instructs people to apply sunscreen to all skin not covered by clothing, remembering the neck, face, ears, tops of the feet and legs . UK dermatology patient guidance for a photosensitive condition similarly directs sunscreen to all exposed areas of skin, especially the head (including balding scalp and ears) and neck, central chest, backs of hands, forearms and legs, if exposed . Clinician explainers from academic medical centres describe the same pattern: the tops, edges and backs of the ears are among the most commonly missed spots, and because ears are exposed year-round they are vulnerable to sun damage; the neck and upper chest receive significant sun exposure but are frequently forgotten during daily routines; and many people forget their hands, which are exposed to sun during everyday activities such as driving . A UCLA Health dermatologist states that people tend to miss the neck area, especially the back of the neck, as well as their ears and the tops of their feet.
On why these sites matter, cancer-information material notes that squamous cell carcinomas usually develop on sun-exposed areas of the body such as the face, ears, neck, lips and backs of the hands .
Findings
✓ What's accurate 6
- The backs of the hands are often left out. In one survey of 214 beachgoers, 49% applied sunscreen to the backs of their hands, and more women than men did so (55% versus 40%).
- The ears are a recognised under-covered site. In a clinic study of people with a previous skin cancer applying sunscreen to their own head, men were about 7.6 times more likely than women to cover the ears adequately, and the authors describe the ears as commonly missed, possibly because of hairstyle.
- A published review of this literature states that incomplete sunscreen application has been demonstrated on the hairline, ears, neck and tops of the feet.
- Dermatology bodies tell people to include these sites. The American Academy of Dermatology says to apply sunscreen to all skin not covered by clothing and to remember the neck, face and ears, and UK dermatology patient guidance names the head including ears, the neck and the backs of the hands.
- These sites do receive sun exposure and are sites where skin cancers occur. Squamous cell carcinomas commonly develop on sun-exposed areas including the face, ears, neck, lips and backs of the hands.
- The post's practical instruction, to extend sunscreen beyond the face, matches what professional guidance says.
≈ What's misleading 4
- The post says "behind the ears" specifically. The measured studies and guidance refer to the ears generally, including their tops, edges and backs. No study was found that measured coverage of the skin behind the ear on its own, so that level of specificity is tighter than the evidence behind it.
- The figures in the evidence come from particular groups in particular settings. The 49% hand figure is from beachgoers in one high-UV location, and the ear findings come from dermatology clinic patients with a history of skin cancer. The post presents the pattern as a general truth without saying who was measured, and no study in South-East Asian populations was located.
- The educational point is carried inside an advertisement for one brand's SPF 50 PA++ sunscreen. Evidence that people commonly miss these sites says nothing about how any particular product performs, and the post's own text is not evidence for its product.
- The post treats covering these areas as the whole task. Measured studies consistently find that people also apply much thinner layers than the amount used to establish a labelled SPF, so "applying evenly" to a site does not by itself mean the labelled level of protection is achieved.
? What's uncertain 4
- How often the neck in particular is missed. Support for the neck comes from a literature summary sentence and clinician guidance rather than from a quantified coverage study retrieved here.
- How often the skin behind the ears is missed, as distinct from the ear as a whole.
- Whether these application patterns hold in Indonesia or in other tropical, high-UV settings with different hairstyles, clothing and daily routines, since the retrieved studies were conducted in the United States and the United Kingdom.
- Whether the pattern holds among adolescents and young adults, the audience the post addresses, as the retrieved studies were in adults and in skin cancer clinic populations.
Sources
7 of 7 linked to recordsDang J, Reserva J, Tung-Hahn E, et al. "Sunscreen application technique amongst patients with a history of skin cancer." Arch Dermatol Res 2020;312(10):739-746
"Sunscreen Use on the Dorsal Hands at the Beach" (cross-sectional beachgoer survey, n=214)
Pratt H, Hassanin K, Troughton LD, et al. "UV imaging reveals facial areas that are prone to skin cancer are disproportionately missed during sunscreen application." PLOS ONE 2017
American Academy of Dermatology, "How to apply sunscreen"
"Completeness of Facial Self-application of Sunscreen in Cosmetic Surgery Patients" (UV photography, n=38), Cutis/MDedge
British Association of Dermatologists patient guidance (sun protection advice listing head, ears, neck, backs of hands)
UCLA Health, Columbia Doctors, Baptist Health clinician explainers on commonly missed sunscreen sites