Sunburn

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Summertime is here, and with it comes the annual issue of sun protection. Evidence continues to mount that sunlight poses health threats. Over time, over-exposure leads to sunburn with discomfort, wrinkles, freckles, cataracts, and skin cancers, which are rising at an alarming rate. There is hope however! Minimizing early sun exposure, especially during the first ten to twenty years of life can greatly reduce long-term damage to our skin.

Sun protection should not be a “hard sell.” Instead, it should become part of our daily hygiene routine and protective choices just like seat belts and bike helmets. Children and teens are at particular risk for sun damage in part because they spend much more time outdoors than adults. The average child receives more UV radiation annually than the average adult does. It is estimated that approximately 80% of a person’s lifetime exposure occurs before 21 years of age. Furthermore, melanin, which gives skin its pigment and blocks some of the sun’s rays, is at its lowest level during infancy and childhood when the skin is relatively thin. Daily sun smart choices involve:

  • Protect – for infants less than six months avoid direct exposure; cover with hats, long sleeves and umbrellas; older children should have this supplemented with sunscreen SPF 30 or greater.
  • Avoid peak hours 10:00-2:00.
  • Apply – early. Sunscreen should be applied one hour prior to exposures to bind with the skin and be active. Reapply after water play.

Since there are no very effective means for treating sunburn once it happens, prevention is key. Sunscreen is one of the best methods for doing this. It is important for the parents to remember that sunscreen isn’t only for the beach. Children should use it – generously – whenever they play outdoors. Some of the various treatments that have been used for symptomatic relief of sunburn include over the counter medications such as Ibuprofen, cool baths, topical cortaid cream, and lots of liquids by mouth. Topical aloe vera, jojoba oil, and vitamin E have been long recommended, but have never shown to change the course of sunburn. Some of these remedies may offer some amount of increased comfort while the sunburn runs it’s natural course. Probably one of the most effective remedies is using cool compresses like cold washcloths or ice packs to the burned area. It is also important to realize that once redness is developing on the skin, this redness will continue to progress even after getting out of the sun for several hours. Therefore, if you’re at the pool or beach and notice some redness you should get out of the sun immediately.

Tanning, with its unfortunate cosmetic appeal, is simply a marker of skin damage. It is important to change our way of thinking about tan skin and start looking at it as a sign of damaged unhealthy skin. Although tan skin does afford some degree of protection it is important to realize that substantial injury occurs to get to that point. A more preferred way to protect from the sun is to choose an effective sunscreen. If properly applied an SPF of 15 offers protection against 93% of the ultra-violet rays which means that you can stay in the sun approximately 15 times longer than with no sun protection and get the same amount of exposure. It is important to remember that this can offer increased protection, but should not be a substitute for limiting overall sun exposure. Sunscreen, however, has to be applied to be effective. Some important principles of proper application include applying the sunscreen approximately an hour before sun exposure-this allows the sunscreen to bind to the skin and be active. It is also important to choose a sunscreen that matches the type of activity. For instance, if you will be doing a lot of water play, choosing a waterproof sunscreen will be beneficial. Sunscreens should also be applied thickly otherwise the SPF may be much lower than that stated on the bottle. There should also be a pattern of application to avoid missing areas. Frequently missed areas are along clothing lines and at the top of bathing suits. Application is greatly enhanced if a second person is used to apply sunscreen to areas such as the back. People should also take special care around surfaces such as sand, snow, concrete, and water, which can reflect up to 85% of the sun’s damaging rays. Beach umbrellas offer only 50% protection from ultra-violet rays because they do not block the rays reflected off the sand. A cloudy day does not preclude the need for protection since up to 80% of ultra-violet rays can penetrate cloud cover.

Here are some tips for choosing a good sunscreen. There are two types of sunscreens. One is chemical sunscreen which absorbs some of the sun’s damaging rays. The other is physical sunscreen such as zinc oxide and titanium dioxide, which work by reflecting, scattering, and physically blocking ultra-violet radiation. Physical sunscreens tend to be better because of their ability to block the entire ultra-violet spectrum as well as a portion of visible light. Label reading is helpful in choosing a sunscreen. The better agents are the physical blocking agents, titanium dioxide and zinc oxide. Other chemical agents that are commonly used and very effective are the cinnamates, the salicylates, and the benzophenones, and PABA. It is important to choose a formulation that goes on smoothly and feels good on the skin since this will encourage frequent usage. Sometimes you might need to try several preparations before you find one that works well with your skin type.

Protecting the eyes is also important. Children as young as one year should wear sunglasses capable of blocking 99-100% of UVA and UVB. The glasses should be labeled “UV absorption up to 400nm” or “maximum of 99% UV protection” or “special purpose” or “meets ANSI UV requirements”.

Sunglasses in children sizes are available at many optical stores as well as convenience stores. The darkness of the lens does not indicate the degree of ultra-violet protection as the chemical applied to the lens is invisible. If your child has a pair of glasses that fit well but do not have 99-100% UV absorption you can often take these to optometry stores and have them dipped with this protective chemical.

Another question that comes up often is tanning bed use. Most tanning salons use units that emit UVA radiation and claim to be “safer than the sun.” In reality, tanning beds are not calibrated and they often emit 2-5% of UVB as well as UVA radiation. Furthermore, the UVA radiation tends to be more damaging than natural sunlight since it is in a higher range. It is estimated that one thirty-minute tanning session per week increases the risk of skin cancer to 30% above baseline. In short, tan skin is damaged skin.

“Artificial tanning” is a safe option. For those of us who still feel that tan skin “looks healthier” one option is using artificial tanners. The active ingredient in these compounds is dihydroxyacetone. This combines with the skin to produce a brown color. The pigment is gradually removed over a span of two to four days. Since this “tan” does not decrease the skin’s susceptibility to sun damage the tanning compound should be used in conjunction with sunscreen during sun exposure. Most major sunscreen manufacturers offer sunless tanning products.

In short, keep your skin healthy and avoid sunburn. Sunscreens should be used on a regular basis as well as sun smart behavior to protect your skin from the cumulative damage of the sun. Evidence is strong that chronic sun exposure is a primary risk factor for the development of skin cancer. It is important to begin to think about protecting your skin as a part of basic hygiene and protective choices. Have fun in the sun but use sun smarts.