As the summer sun sizzles, encourage sun protection

Paller A. Pediatrics. 2011;doi:10.1542/peds.2010-1079.

The skin barrier remains immature throughout at least the first 2 years of a child’s life, and ultraviolet radiation-induced changes in the skin may start as early as a baby’s first summer. Therefore, encouraging different methods of sun protection are important, according to a review article published online this month.

Amy S. Paller, MD, of the department of dermatology and pediatrics in the Feinberg School of Medicine at Northwestern University in Chicago, and other dermatologists wrote in their review that infants and toddlers are thought to be “unusually vulnerable to ultraviolet radiation (UVR) because of lower levels of protective melanin, a thinner stratum corneum and a higher surface area/body mass ratio.”

In their review, the dermatologists wrote that is important not to treat children as little adults when it comes to sun protection. There are special considerations when discussing with parents how to protect children from the harmful rays of the sun. Unfortunately, data on the best methods to prevent sun exposure in children are lacking, the researchers wrote.

In their review, Paller and colleagues began by defining what methods are useful to protect children against harmful UVR rays. Similar to the AAP, Paller and colleagues encouraged pediatricians to discuss sun avoidance in infants aged younger than 6 months, but they said there are circumstances in which avoiding the sun is not possible. In these cases, the AAP recommends liberally applying sunscreen on exposed skin.

For older children, the researchers said pediatricians should also counsel about “comprehensive sun protection,” which the dermatologists define as avoiding “peak sun exposure, wearing protective clothing and using sunscreen.” Additional helpful hints to avoid overexposure to the sun include dressing children in brimmed hats and “lightweight but tightly woven clothing, which is less susceptible to UVR penetration.”

Regarding sunscreens, several options are available, but the best ones minimize irritation to the eyes and skin. Oil-based emulsions of inorganic filters are promising protectants; however, the researchers said, “such emulsions have traditionally been associated with more greasiness, which reduces compliance, and has higher acidity, which can cause skin irritation.”

Most people do not generally apply enough sunscreen, so pediatricians should remind patients and parents about the importance of generously applying sunscreen and reapplying throughout the day. These emulsions also have yet to be tested in infants, according to the study researchers.

Paller and colleagues had several suggestions for future areas of study, including “definitively establishing that sun avoidance in the first 6 months and vigorous sun protection thereafter during infancy prevents melanogenesis-related DNA damage,” as well as “elucidating the time course of pigmentation in sun-exposed areas compared with the development of the skin barrier and immunity [to assist] making decisions about sunscreen use.”

Sunscreens that are recommended for use in pediatric populations should be thoroughly evaluated “for broad-spectrum protection, safety, skin absorption and reactivity,” they wrote, adding that studies in certain populations, including those infants with atopic dermatitis, are needed.

The lack of currently published data on sun protection in children “underscores the need for more research to establish evidence-based standards of care in this area,” the researchers concluded.

Disclosures: All reviewers who are not employed by Johnson & Johnson were provided with honoraria to compensate time spent at a roundtable on infant sun protection, which was supported by Johnson & Johnson. This preceded the review, but no researcher was compensated for conceptualizing, planning or writing the review.

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