title: Sunscreen Product Performance and Other Determinants of Consumer Preferences.
abstract: 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.
  
  
  
  To determine the characteristics and the most commonly cited positive and negative features of highly rated sunscreens described by consumers.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Shuai
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Kwa
authors.affiliation: Duke University School of Medicine, Durham, North Carolina.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.affiliation: Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Roopal V
authors.initials: RV
authors.lastname: Kundu
mesh_terms: D003132:Commerce; D003258:Consumer Behavior; D006801:Humans; D020407:Internet; D063465:Skin Cream; D059405:Sun Protection Factor; D013473:Sunscreening Agents / Q000008:administration & dosage / Q000737:chemistry / Q000191:economics* / Q000592:standards*
chemical_list: D013473:Sunscreening Agents