Skin Reactions to the Sun

By Ara Jamasbi, pediatric resident at CHOC Children’s

Living in Southern California, we are lucky to experience beautiful sunny weather practically year round. While we’re all aware of the dangers of sunburns, there are other skin reactions to the sun to be mindful of as well.

Photosensitivity is abnormal or adverse skin reactions to the sun. and If your child develops a sunburn reaction, swelling, or intense itching after limited exposure to sunlight or shows a rash or scarring in a sun exposed area (ie. face, V of neck), they may actually have photosensitivity.

Polymorphous light eruption, also known as “sun allergy” or “sun poisoning” is the most common photosensitivity. It occurs 1-2 days after intense sun exposure. It may range from small red dots to clear fluid-filled dots (vesicles), eczema-looking dry patches, large plaques/papules, or target-like lesions. The commonly involved areas include the face, neck, arms and hands where there was sun exposure. In children, it starts as dry patches on the face with red small dots, with severe itching. Lesions disappear in 1-2 weeks spontaneously if no further sun exposure occurs.

Solar urticaria is another type photosensitivity characterized by itching and redness usually after about 30 min or less of sun exposure. After several hours, the skin returns to normal. The cause is unclear, but antihistamines, corticosteroids and limited sun exposure have all been beneficial.

Phytophotodermatitis occurs when UV light reacts with certain chemicals on the skin. These chemicals can come from common foods such as limes, carrots, parsley and celery. The rash typically appears 24 hours after the exposure, and can take weeks to months to completely resolve. It may appear as a red itchy rash, but sometimes may even blister. It is usually in the pattern of exposure to the food causing the reaction, such as spattering or drips from a squeezed lemon

Don’t forget basic sunscreen practices. It is important to use a water-resistant, broad spectrum sunscreen (protecting against both UVA and UVB rays) with SPF 30 or higher. The higher the SPF, the more protection, with SPF 50 giving maximal protection. Sunscreen should be applied 15-30 minutes before going outside and re-applied every two hours, but more often if the child is swimming or sweating. Throw away sunscreen that is older than three years or passed the expiration date. Don’t forget to put sunscreen on often-forgotten areas such as the tops of the feet, ears and back of the neck and scalp.

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Summer Safety: What’s in Sunscreen?

By Melody Sun, clinical pharmacist at CHOC Children’s

The skin is the largest organ of the body, and our best protection against the outside environment. Sunlight stimulates the skin to produce vitamin D, however, daily prolonged exposure to radiation from the sun can cause wrinkles, freckles, and, in the worst case, skin cancer. Sunscreen can protect the skin so that it can continue to protect the rest of the body. Remember that radiation from the sun penetrates the skin even on cloudy and snowy days, so it is important to apply sunscreen whenever going outside.

Knowing when to apply is the first step, but what is the difference between products? Navigating your way through the endless number of products can be challenging. The active ingredients, which are listed in the Drug Facts Label, protect the skin from different types of ultraviolet (UV) radiation called UVA and UVB. UVA reaches deeper into the part of the skin that provides support and nourishment to the rest of the skin layers. UVB can damage the part of the skin that contains important structures such as blood vessels and nerve endings. Sunscreen protects the skin by reflecting or absorbing the radiation.  The ‘reflective’ property is not as strong as the ‘absorptive’ property because the UV radiation can hit other areas.

Let the following table be a guide to help you understand the ingredients in your sunscreen, and how each of them is important in helping protect you and your family.

Active Ingredient Radiation Coverage Considerations
UVA UVB
Absorbs radiation
Avobenzone

Best UVA coverage. Must be in combination with other ingredients (ie, octocrylene). However, may degrade other sunscreen ingredients.
Ecamsule ✔ (partial) Must be in combination with other ingredients (ie, octocrylene). Less water resistant.
Oxybenzone ✔ (partial) Can cause allergic reactions, not water resistant
Padimate-O

Glycerol PABA

Most potent UVB absorber, potential for allergic reactions (related to PABA)
Octocrylene Stabilizes other ingredients.
Octinoxate

Cinoxate

Water resistant, avoid combination with avobenzone (destabilizes avobenzone’s UVA protection).
Octyl salicylate (octisalate)

Trolamine salicylate

Homosalate

Stabilizes other ingredients, water resistant, less potent in UVB absorption than others
Ensulizole ✔︎ Less oily application, not water resistant
Reflects and disperses radiation
Titanium dioxide Transparent formulations available
Zinc oxide Leaves whitened layer on skin and clothing

Note: The above chart is not all inclusive.

Consider the following guidelines when making your selection:

  • Make sure the combination of active ingredients covers both UVA and UVB
  • If you’ll be sweating or around water, select a combination that is water-resistant.
  • ‘Water resistant’ labeling means the product retains its activity for at least 40 minutes in water. ‘Very water resistant’ means at least 80 minutes.
  • Will you be in the sun all day? If so, select a higher SPF depending on your skin tone and individual sensitivity to sunburns.

Consult your child’s pediatrician with questions on specific sun prevention mechanisms for your family.

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Sun Smarts: Kids, Sunscreen and Melanoma

This article was featured in the Orange County Register on August 19, 2013 and was written by Shaleek Wilson.

View the full feature

CHOC_08-20-2013_sunscreen_half

SUNLIGHT EXPOSURE

Orange County is one of the sunniest places in California, with hundreds of sun days per year. With that comes the need for protection. Improper protection can increase risk for skin cancer. “People get skin cancers, the most serious being melanoma, because we get too much exposure to the sunlight,” says Dr. Sender. To ward off harmful UVA and UVB rays, use sunscreen. “Most people don’t put enough on,” explains Dr. Sender. “We recommend about an ounce for each area of exposed skin, i.e. leg or arm.”

THE RIGHT NUMBER

SPF stands for Sun Protection Factor. It should be applied liberally and more often than most people think, he explains. “Sunscreen should be put on 30 minutes before you go out in the sun,” says Dr. Sender. So, what’s the magic number? 15? 50? 100? “Never go in the sun with less than SPF 30,” he says. “Use the broad-spectrum variety and reapply every two hours.”

MORE ABOUT MELANOMA

Melanoma accounts for 4% of all skin cancers. Malignant (life-threatening) melanoma starts in cells that produce pigment (color) in skin. It usually begins as a mole that turns cancerous. People with all skin types may be affected, but those who are fair-skinned and burn easily are at a higher risk, says Dr. Sender.

THE ABCD’S OF MOLES

Although melanoma is still rare in kids, parents should make checking for moles part of their monthly routine. Look for Asymmetry, Border, Color and Diameter. “Get to know your child’s skin; if all the moles look the same and one is different, that’s the one you need to worry about,” Dr. Sender says. “It should never be bigger than a pencil eraser.”

With early detection, melanoma is curable, so be safe and use common sense in the sun:

  • Apply sunscreen, even on infants 6 months and older
  • Wear wide-brimmed hats
  • Protect your eyes; wear sunglasses

FAST FACTS

  • Cases of skin cancer in the U.S. every year: 1.3 Million
  • Percentage of sun rays blocked when SPF 30 is applied: 90%
  • Time of day when the sun is the strongest: 10am – 4pm

 

CHOC Pediatric Cancer Specialist
Dr. Leonard Sender
CHOC Pediatric
Cancer Specialist

PHYSICIAN FOCUS: DR. LEONARD SENDER

Dr. Sender is the Medical Director of Hyundai Cancer Institute at CHOC’s Children’s as well as CHOC Children’s Specialists Division chief of Oncology; and Medical Director of Clinical Oncology Services at UC Irvine Medical Center’s Chao Family Comprehensive Cancer Center. He completed his fellowship in Pediatric Hematology/Oncology including Hematopoietic Progenitor Cell Transplantation.

EDUCATION:
University of Witwatersrand School of Medicine, South Africa

BOARD CERTIFICATIONS:
Pediatric Hematology/Oncology

More about Dr. Sender

 

Have a Safe Summer!

Summer is in full swing, and it’s all about safety this season, whether your family is enjoying a fun day at the beach, or a barbecue in your backyard! Check out these helpful reminders to ensure your little ones have a fun and safe summer. Don’t forget to check back on the CHOC Blog for more summer safety guidelines.

Be Aware of Pool, Spa Dangers

Drowning is the second-leading cause of unintentional injury-related death in children ages 1 to 14. Nothing replaces constant supervision. However, layers of protection like fences, door and window alarms, and pool covers will buy you precious seconds if you are momentarily distracted. Here are other important things to know about pool and spa safety:

• Stay away from the drain — Hair and body parts may become entrapped by the drain’s powerful suction. If you have a pool or spa, have it checked by a professional. A professionally installed “anti-vortex” drain cover may help minimize the risk.
• Never swim alone — And that goes for grownups, too.
• Invite a “Water Watcher” to all pool parties — Designate one adult to watch the water at all times. Ask another to watch the children. It’s simple, and it can avert a tragedy.

Protect Your Child’s Skin

Deadly skin cancers are being diagnosed at increasingly younger ages. Researchers have linked this alarming trend to childhood sun exposure. Protective steps you take now will pay off in the years to come:

• Slop it on — Apply 30 SPF sunscreen every day. Cover all exposed skin, including hands, ears and the back of the neck. Reapply after swimming or if your child perspires excessively.
• Keep it cool — Schedule outdoor activities before 10 a.m. or after 2 p.m.
• Cover up — Outfit your children with broadbrimmed hats and protective clothing that covers the arms and legs.
• Protect those peepers — Choose real (not toy) sunglasses with polarized lenses for your children.

Play It Safe

Your local playground is a great place to get exercise. First, take a moment to make sure it is safe:

• Check for hidden hazards — Look carefully for razor blades, broken glass, insects or snakes.
• Examine the equipment — Stay away from any with sharp points or broken edges. Avoid swings that have “S” hooks at the bottom of the seat.
• Ensure a soft landing — Make sure play equipment has at least 12 inches of mulch, wood chips, sand or pea gravel, or mats made of safety-tested rubber.
• Remove all strings — Never let your child play on equipment while wearing a backpack or clothing with strings.

For more information about summer safety, visit www.choc.org. CHOC Community Education offers “Three Tragic Seconds,” a pool safety class for parents and caregivers. To schedule a presentation, please call CHOC Community Education at (714) 509-8887.

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Sun Safety Tips for You and Your Family

May is Melanoma/Skin Cancer Detection and Prevention Month, a perfect time to talk to your kids about sun safety. Check out these sunburn and skin cancer preventive tips recommended by the American Academy of Dermatology (AAD) and the Skin Cancer Foundation.

1. Minimize exposure to the sun at midday – between the hours of 10 a.m. and 4 p.m.

2. Apply sunscreen, with at least a SPF-15 or higher that protects against both UVA and UVB rays, to all areas of your child’s (older than 6 months of age) body that are exposed to the sun.

3. Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.

4. Make sure your child wears clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye by filtering as much as 80 percent of the rays, and protecting the lids of the eyes, as well as the lens.

5. Avoid exposure to UV radiation from sunlamps or tanning parlors.

6. Protect children from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.), and apply sunscreen liberally and frequently to children 6 months of age and older.

The American Academy of Pediatrics (AAP) approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents also may apply a minimal amount of sunscreen to the infant’s face and back of the hands.

Remember, sand and pavement reflect UV rays even under the umbrella. Snow is a particularly good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the damaging sun rays.

For more information, check out the CHOC Health Library on choc.org at http://www.choc.org/healthlibrary/topic.cfm?PageID=P01922

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