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Dear Dr. Lanny:
My daughters, ages 5 and 7, are very active and in and out of the pool all summer long. What value is there in applying sunblock to their skin every time they roll around in the grass or get wet? What type of sunscreen (SPF, etc.) do you recommend? Please don’t tell me to keep them indoors during the sunniest hours; summer vacation is challenging enough without restricting outdoor time, and isn’t some sunlight good for them anyway, especially in mostly overcast Central New York?
A: Before discussing sunscreen, I must say that I strongly believe in the benefits of sunshine and fresh air year-round. I also believe in just fresh air without the sunshine, a common situation during much of our year.
As global warming progresses, and there is no doubt that it is doing so, people will be outside with less clothing for greater parts of the Syracuse year. Whether on the baseball field, the golf course or in the local park, this means a significant increase in annual exposure to the sun’s rays. I was on my bicycle a number of times by mid-April; that is definitely earlier than usual for Syracuse and a sign of things to come.
I don’t mean to be Grinch-like, but there is no doubt that moderating your children’s sun exposure from mid-morning to mid-afternoon is the safest, most effective and cheapest course of skin protection. I understand that such a suggestion is seemingly impractical and un-American, but the sun’s rays are most damaging during that period.
A reasonable course is to wear long sleeves and pants, and a wide-brimmed hat when not swimming, and I do understand that this too feels constraining. However, skin damage from the sun’s rays is real, as is the increase in skin cancer around the world. I am not suggesting that we become afraid to be in the sun, but I am trying to make clear that the sun’s power is to be respected for its potential to harm.
And now to our rescue come sunscreens! Well, not so fast. Sunscreens, and there are many different chemical types, are by no means a free pass to all-day sun exposure.
Sunscreen is just that—a screen. It decreases the ultraviolet light that gets to your skin, but it does not totally block it. The SPF number of a sunscreen is a guideline to the degree of protection against UV-B, but not UV-A, rays. An SPF of 30 means it should take 30 times longer to get sunburned than if you used no protection. In other words, if unprotected skin would burn in 10 minutes, 30 SPF protected skin would burn in 300 minutes, or five hours. Since our main concern is the midday sun, an SPF greater than 30 is probably unnecessary. As mentioned earlier, SPF ratings do not take UV-A rays into account. This is very important as UV-A rays can cause wrinkling and skin cancer. When purchasing a sunscreen, you need to be sure that it protects against the A and B ultraviolet rays. Many products do not.
Waterproof is a relative term, most applicable to the child who stands in one place doing nothing. Kids have a funny habit of being playful: wrestling with each other, climbing in and out of the pool, rubbing on tubes and other toys, and even occasionally coming out of the water and toweling off. All of these activities will remove sunscreen.
Reapplication every few hours is recommended by manufacturers and dermatologists alike. Consumer Reports suggests that an adult needs approximately 2 to 3 tablespoons of sunscreen per application. Two tablespoons equal one ounce. You can use this as a guideline for comparative pricing. A Consumer Reports review from last year shows widespread price variation in waterproof products that offer UV-A and UV-B protection, from 63 cents to $9.38 per ounce!
Unless your hobby is throwing away money, always check ingredients for UV-A and UV-B protection as well as for cost per ounce. Take advertising with large grains of salt. To further complicate life, nanotechnology—products made with unbelievably tiny particles—is now finding its way into many products including sunscreens. This is all new and its effect on health, positive or negative, is not yet clear. Again, be wary of advertising claims.
If you read about sun exposure, you will at some point find that there is evidence of increased skin cancer possibly associated with the use of sunscreens. This may relate to people having an excessive sense of security when wearing sunscreen, and therefore spending increased time in the sun. Or possibly because they have used a sunscreen without adequate UV-A protection.
Until further evidence is available, it remains wise to limit sun exposure, wear protective clothing whenever possible, relax or eat in the shade, wear UV protective sunglasses (always check the label), and use sunscreen effective against UV-A and UV-B rays.
Please remember that there really is no safe tan. A tan is your body’s effort to protect itself against dangerous radiation.
Despite my seeming aura of doom and gloom, I hope to swim in the ocean this summer, and I will be out bicycling whenever possible. I’ll be the one covered from head to toe, riding a red and blue Trek bicycle. Watch for me!
Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.