7 minute read
SUN PROTECTION
The Importance of Sunscreen
By Wendy Ripple, MD
The sun is the life giving energy source for our
planet. Without the sun, we would cease to exist. Its energy is necessary for our very being. But, like many things that are good for us, the sun with its powerful rays can be detrimental to our health as well. Too much exposure to the harmful UVA and UVB rays emitted from the sun can, over the years, cause irreparable skin damage and skin cancer. It is estimated that 1 in 5 Americans will, over their lifetime, develop skin cancer. These detrimental effects of the sun begin with exposure during childhood and accumulate with ongoing exposure over the years. Freckling, age spots, thinning of the skin that many adults have on their shoulders, chests, hands and faces are a result of years of ongoing sun damage. Precancerous skin lesions that develop around or after age 40 have their beginnings in youth.
Pediatricians and others who care for young children know and understand these risks and often begin discussing approaches to sun protection as part of well child anticipatory guidance at a very young age. Despite ongoing education, the incidence of melanoma and other skin cancers is increasing in the United States, and the age at which we are seeing such is becoming younger and younger. Drawing on recent information and recommendations from the American Academy of Pediatrics (AAP) and the American Academy of Dermatology (AAD), this article will provide a brief overview and reference for parents and patients regarding sun protection plans for the whole family.
Often patients say, “I wear sunscreen, but still get sunburn. What should I do? Sunscreen just does not work for me.” These are common complaints that stem from the common misconception that sunscreen is all that is needed to protect the skin from harmful effects of the sun. This is simply not true. Sunscreen is only one tool - and at that, an imperfect tool. When used properly and as a part of a comprehensive sun protection plan, sunscreen can be effective in protecting the skin from the sun’s harmful rays. Both the AAD and the AAP agree that the following are important first steps in protecting children from harmful effects of the sun: 1. Avoid the sun when the sun’s rays are strongest between 10 a.m. and 2 p.m: If your shadow is shorter than you are, seek shade, keep children under umbrellas, etc. Even on cloudy days, the sun’s UVA and UVB rays can be harmful to the skin. Prioritize outdoor events before 10 am or after 2 pm.
2. Wear sun protective clothing: Lightweight long-sleeved shirts and pants, a wide-brimmed hat and sunglasses, neck gaiters, long-sleeved rash guards when swimming, etc. Many companies now make clothing with sun protective factors (SPF).
3. Use extra caution near water, snow, and sand: The sun’s rays are reflected from these and can increase the likelihood of too much exposure and sunburn.
4. Eat a healthy diet with a source of vitamin D: Do not rely on the sun solely for vitamin D. Health food sources include (1) Fatty fish, like tuna, mackerel, and salmon, (2)
Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals, (3) Beef liver, (4) Cheese, and (5) Egg yolks.
Sunscreen, then, the other component to a comprehensive sun protection plan. The AAD stresses that EVERYONE should use sunscreen regardless of age or skin type; even those with darker skin tones that ‘never burn’ need to protect their skin. Remember, a suntan is evidence of sun injury. The AAP and the Food and Drug Administration (FDA), the agency that regulates over the counter medications including sunscreens, recommend the use of sunscreen with SPF 15 or higher. The AAD recommends the use of sunscreen with SPF 30 or higher that is water-resistant. Sunscreen with an SPF of 30 blocks about 97% of the sun’s harmful rays, and while higher SPFs exist, no agent will block 100%. Using an SPF greater than 30 may give one a false sense of security of added protection that prevents appropriate use.
Importantly, all agencies recommend the use of a broad spectrum sunscreen. By definition, a broad spectrum sunscreen protects against both UVA (aging rays) and UVB (burning rays). Broad spectrum agents contain zinc oxide and/ or titanium dioxide which are minerals that physically block the sun’s rays from penetrating the skin by reflecting and scattering the rays from the skin’s surface. Zinc oxide and titanium dioxide are “generally regarded as safe and effective” by the FDA. These products are also the most hypoallergenic and suitable
for sensitive skin or patients with skin conditions such as eczema.
The type of sunscreen used is a matter of personal choice, and may vary depending on the area of the body to be protected: creams are best for dry skin and the face, gels are good for hairy areas, solid sticks are good to use around the eyes. Sprays are often seen as easiest to apply, but contain many more chemicals that are still under review by the FDA; they also pose inhalation risks and are best avoided in children. Nowadays, many cosmetics such as makeup and moisturizers contain sunscreen as well for ease of daily use.
Sunscreen only works if applied in the proper amount and with the proper frequency. Applying too small of an amount is likely a major reason for failure. Adults and children should use 1 ounce of sunscreen, a shot-glass full, to cover the entire body. Smaller toddlers may require less. Sunscreen should be applied 15 minutes prior to going outside, and should be reapplied every 2 hours, or after swimming or sweating. Sunscreen should be applied to the ears, lips, tops of feet, head, back of the neck and other commonly forgotten areas.
While the FDA and the AAD have concluded that all sunscreens currently available in the United States are safe and effective as part of a comprehensive sun protection plan (Wang SQ, Lim HW. J Am Acad Dermatol. 2019;81:650-651, https://bit.ly/2WWBSLm), sunscreen of any kind, should not be used in infants under the age of 6 months. Many companies market “Baby” formulations, and the AAP concedes that a small amount may be used and only in limited areas, but young infants should be kept out of the sun and dressed in appropriate lightweight clothing when sun exposure is unpreventable.
The AAP cautions against unproven sun protecting agents such as some sunscreen pills available online as they are not proven to be effective or safe and lack any regulation in their formulation, marketing and distribution. The AAP also cautions against homemade sunscreens. There are some studies of homemade sunscreens which show 68% of the recipes do not afford adequate protection from UVA or UVB rays. Some sunscreen recipes included unsafe ingredients and oils that can cause contact rashes.
In summary, who does not love the sun? Who does not feel better after time spent outdoors in its warmth? One can love and enjoy the sun responsibly with a mindset that includes a comprehensive sun protection plan. While total sun avoidance is not the goal, reducing the amount of sun exposure by timing outings, protecting skin with clothing and sunscreen makes for a healthier summer and reduces the risk of sun damage, photoaging, and even skin cancer into adulthood. Healthy sun habits during the early childhood years will provide a model for young adults to carry through their entire lifetime.
Wendy Ripple, MD, is a pediatric dermatologist who cares for young people’s skin conditions from the inside out. She treats acne, warts, and rashes and provides skin checks and mole biopsies. Dr. Ripple earned a medical degree from the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania. She completed a residency and a pediatric fellowship at Children’s Hospital of Pittsburgh in Pittsburgh, Pennsylvania and is certified by the American Board of Pediatrics. Dr. Ripple is based in Erie, PA, and she sees patients from birth to age 26.
For more information on healthy sun habits for children and adults, please see the following links:
www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-howhelp-protect-your-skin-sun
www.aad.org/news/aada-statement-on-sunscreen-access
www.aappublications.org/news/2020/06/01/focussunprotection060120
Now that Pediatric Alliance is part of Allegheny Health Network, we’re moving from Patient Portal to MyChart.
MyChart is a secure online platform that gives you a quick and easy way to connect with our office: • Book appointments • View test results • Communicate with our care team • Request prescription refills • Review your child’s health history • Pay bills and view statements Follow these steps to register for MyChart now: 1. Visit mychart.ahn.org and click “Sign Up Now.” 2. On the next screen, under “No activation code?” click “Sign Up Online” and follow the onscreen prompts. 3. Once you’re logged in, click “Profile” in the top right and then “My Family Access.” 4. Based on your child’s age, follow the instructions to get proxy access.
