What I’m telling my patients and families about sunscreen

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Children and adults alike should protect their skin from the sun’s harmful rays to lessen the risks of sun damage.

A recent study published in the Journal of the American Medical Association found some chemicals in sunscreens can be absorbed into the bloodstream.

Four chemicals that block ultraviolet rays — avobenzone, oxybenazone, octocrylene and ecamsule — were detectable in the bloodstream in amounts that warrant further investigation. Frankly, it isn’t clear if this presents a safety issue, and more study is needed. The study also concluded that sunscreen should continue to be used.

But the study involved adults. What should parents do for their children?

Because children spend more time playing outdoors, a significant amount of lifetime sun exposure occurs before the age of 18. There is overwhelming evidence that chronic sun exposure and sunburns (particularly in childhood) increase an individual’s lifetime risk of all forms of skin cancer, including melanoma (the deadliest form of skin cancer).

Two types of sunscreen

There are two ways you can protect your skin from ultraviolet rays. One type of sunscreen is a physical blocker — think of zinc oxide and titanium oxide — that sit on the surface of the skin and block UV rays. The other, called a chemical blocker, allows UV-blocking chemicals to work while being absorbed into the skin.

Although we knew that chemical sunscreen ingredients could be absorbed into the skin, this recent study showed that they can be detected in the bloodstream — which has raised the question of safety. In general, I tell parents to choose sunscreen products that contain physical blocking agents — zinc oxide and/or titanium oxide — and avoid the products containing the chemical ingredients.

How do I protect my child from excessive sun exposure?

Proper sun protection has several components:

  1. Avoid deliberate sun bathing and indoor tanning.
  2. Seek shade whenever possible (especially between 10 a.m. and 4 p.m.).
  3. Wear protective gear, including clothing, a wide brimmed hat and UV protective sunglasses.
  4. Use broad spectrum sunscreen regularly and correctly.

What should I look for in a sunscreen?

Look for a product with an SPF (sun protection factor) of at least 30. Products marketed for children will often have an SPF of at least 50. Look for a product with “broad spectrum” coverage, meaning it protects against both ultraviolet A and B rays from the sun. For younger children and children with very sensitive skin, it’s best to select products containing physical blockers. Also, look for products that are sweat and/or water resistant.

How should I apply sunscreen?

For maximum protection, sunscreen must be used correctly. Do not skimp! It should be applied generously at least 15 minutes before going outdoors. It takes approximately one ounce (six teaspoons) of sunscreen to adequately cover an adult of average size. Sunscreen should be reapplied at least every two hours, but more often when swimming and sweating.

Can I apply sunscreen to my baby?

Infants under the age of 6 months should be kept out of direct sunlight as much as possible. Sunscreens containing physical blockers can be applied to small areas of exposed skin, such as the face or back of the hands. Products that come in a stick are especially easy to apply to delicate areas, such as the nose, cheeks and ears.

Are spray sunscreens safe?

Recently, there have been concerns regarding the safety of spray sunscreens due to the possibility of inhaling the product during application. Until the FDA has conducted a more thorough investigation, many organizations are recommending avoiding the use of spray sunscreens on children. If you have nothing else available or decide to continue using these products, please do not spray the product directly on your child’s skin. Instead, spray it into your hand, well away from the child’s face, and rub it onto the skin.

What else can I do to protect my child?

More than one million new cases of skin cancer are diagnosed each year in the United States, and roughly one in five Americans will develop some form of skin cancer during their lifetime. In 2019, the American Cancer Society estimates there will be nearly 95,500 new cases of melanoma.

If you don’t have the physical blocker type of sunscreen handy, that doesn’t mean you should not use sunscreen at all. Protecting your skin from sun exposure is more important.

Remember to set a good example by protecting yourself. Many of us grew up in a time when sunburn was simply accepted as part of spending time outdoors. Now that we have better information about the harmful effects of excessive sun exposure, we should make every effort to protect ourselves and our children as much as possible.

About the Author

Teresa Wright
Teresa Wright, MD, is division chief of Pediatric Dermatology at Le Bonheur Children’s Hospital. She is also a consulting physician in Surgery at St. Jude Children’s Research Hospital and a member of the St. Jude Pediatric and Adolescent Melanoma Referral Clinic medical team.