The past five years have seen a surge of attention when it comes to sun protection. In 2014, the U.S. Surgeon General issued a “Call to Action” for skin cancer awareness and prevention, and specifically called out health care providers to educate our patients about sun safety.
Why is this a high-priority topic?
Sun exposure in childhood is an important risk factor for the development of skin cancer later in life. Even one sunburn is dangerous. A 2008 meta-analysis published in the Annals of Epidemiology concluded that more sunburns meant a higher risk of melanoma. One sunburn prior to age 13 meant a 1.9 times higher melanoma risk.
Tanned skin is sun-damaged skin. Cumulative suntans over time leads to cumulative sun damage and higher skin cancer risk.
In 2015, the Sunscreen Innovation Act was passed with the intent to bring currently unavailable sunscreen products onto the market. Earlier this year in 2019, the U.S. Food and Drug Administration (FDA) released a proposed rule asking for sunscreen manufacturers to provide safety and efficacy data on many chemicals currently used in sunscreen products. New data suggests that certain sunscreen chemicals may have negative effects on coral reefs, leading to bans on the sale and use of oxybenzone and oxtinoxate in select parts of the world.
As trusted sources of information, patients look to us to help them make the healthiest decisions for their children. Here are some key points to consider when having discussions with your patients about the sun:
Empower parents to make a plan for sun protection.
There are lots of ways to reduce sun exposure. Seeking shade or planning outdoor activities before 10 a.m. or after 2 p.m. are simple ways to reduce risk. Recommend sun protective clothing, such as a swim shirt. These garments are easy to find (most large retailers offer them in the swimwear section) and typically cost less than the equivalent amount of sunscreen used over time. Recommend routine use of a hat and sunglasses to protect the scalp, ears and eyes.
Reiterate that sunscreen is safe.
The buzz in the media about sunscreen has sent some parents into a panic. Although the FDA is requesting more safety and efficacy data on many sunscreen ingredients, they have clearly stated that this is not because they are suggesting these products are unsafe. There are no known reports of sunscreen causing harm to humans. More data about sunscreen ingredients will help us make choices based on science instead of fear, and might help drive more choices onto the market. For your youngest patients and patients with sensitive skin, recommend the “physical” sunscreens made with only zinc oxide and titanium dioxide, since these already endorsed by the FDA and tend to be the most hypoallergenic. The coral reef question is one that needs further investigation: some argue that changes in water temperature and other water pollutants are main factors behind declining reef health.
Permission slips for sunscreen are a thing of the past.
Students will be able to possess and apply sunscreen during the school day under a new law signed into law by Gov. Walz. The bill makes clear that school districts must allow a student to possess and apply a topical sunscreen product during the school day, while on school property, or at a school-sponsored event without a prescription, physician’s note, or other documentation from a licensed health care professional.
Ingrid Polcari, MD, FAAP, FAAD, is a pediatric dermatologist at University of Minnesota Masonic Children’s Hospital and an assistant professor in the department of dermatology at the University of Minnesota Medical School.