Education

Evaluation of the acceptance and efficacy of a bespoke sun
protection package for persons with oculocutaneous
albinism living in Malawi
Yolanda Gilaberte1, MD, PhD, Tenganawo E. Mzumara2, MD, Sunganani P. Manjolo3,
Ndamiwe Kaseko3, Lorea Bagazgoitia4, MD, PhD, L. Claire Fuller5, MA, FRCP (UK) and
Mafalda Soto6, MSc

1
Department of Dermatology, Miguel Servet
!n, Zaragoza,
University Hospital, IIS Arago
Spain, 2HOD Dermatology Department,
Kamuzu Central Hospital, Lilongwe, Malawi,
3
Dermatovenereology officer, Dermatology
department, Kamuzu Central Hospital,
Lilongwe, Malawi, 4Department of
Dermatology, Hospital Ruber Juan Bravo,
Madrid, Spain, 5Chelsea & Westminster
NHS Foundation Trust, London, UK, and
6
Beyond Suncare, Madrid, Spain

Abstract
Introduction Skin cancer is the main cause of death in persons with albinism (PWA) in
Africa. Education would minimize sun damage.
Objective To evaluate the efficacy and acceptance of a photoprotection educative and
sunscreen (Umozi Max) package designed for PWA in reducing sunburns and skin cancer.
Patients and Methods A multicenter, noncontrolled, before-and-after, interventional study
was conducted in PWA > 12 years of age, from February to May, 2019, in Malawi. During
the baseline and the follow-up visits (at 8 and 15 weeks), subjects received an educational
program designed to PWA and use of Umozi Max. At every visit, photoprotection behavior
and knowledge were checked and cutaneous lesions were recorded. Univariate and

Correspondence
Yolanda Gilaberte, MD, PHD
Department of Dermatology
Miguel Servet University Hospital
!n
IIS Arago
!lica, 3-4
Pseo. Isabel la Cato
50009 Zaragoza
Spain
E-mail: ygilaberte@salud.aragon.es
Conflict of interest: None.
Funding source: Africa Directo Foundation,
Open Value Foundation and Open Society
Foundations collaborated to support the
study.

bivariate analysis were performed.
Results A total of 210 PWA were analyzed, 50% males, with a mean age of 24.5 (SD
11.29) years. The percentage of people using sun protective clothing increased from 80%
to 100% and sunscreen from 81.9% to 99.5%. People avoiding the midday sun increased
by 38.9% (P < 0.05). Participants that erroneously applied the sunscreen at night
diminished from 40% to 4% (P < 0.001). Absent erythema on the face increased from 40%
to 90% (P < 0.05). The percentage of patients with actinic keratoses (AK) on all locations
significantly decreased during the study. All the participants preferred Umozi Max to
previously used sunscreens. The satisfaction with the program was unanimous.
Conclusion The educational program enhanced the use of all photoprotection measures,
improved behaviors, and decreased the incidence of solar erythema and contributed to
decreasing the incidence of new AKs.

doi: 10.1111/ijd.15793

Introduction
of pigmentation. Its prevalence in Africa ranges from 1/5,000 to

acceptable sunscreens that PWA like to wear are key to ensuring compliance, one of the most important factors for optimal

1/15,000.1 Skin cancer is the main cause of death in persons

ultraviolet (UV) protection.

Oculocutaneous albinism is a group of rare inherited disorders

with albinism (PWA) in Africa. Many PWA develop advanced

Regular use of broad-spectrum sunscreens has been shown

skin cancers in the third to fourth decade of life.2,3 Measures to

to reduce photoaging and skin cancer risk, especially squamous

minimize sun damage are necessary to prevent avoidable
deaths. These include: sun avoidance, wearing sun protective

cell carcinoma, the most common type of skin cancer in PWA

4

in Sub-Saharan Africa.4–8

clothing, and regular application of sunscreens as well as regu-

The objective of this study was to evaluate the efficacy and

lar clinical review to detect and treat early skin cancers. Provid-

acceptance of a sun protection package tailored for PWA in
Malawi to reduce the incidence of sun-induced skin lesions. In

ing comprehensive photo-education services and cosmetically

ª 2021 the International Society of Dermatology.

International Journal of Dermatology 2021

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