Importance: 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. Objective: To determine the characteristics and the most commonly cited positive and negative features of highly rated sunscreens described by consumers. Design, Setting, and Participants: 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. Main Outcomes and Measures: The Kruskal-Wallis testwas 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. Results: 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). Conclusions and Relevance: 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.
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