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 1

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