SUSAN CINGARI: Hello, I’m Susan Cingari, and thanks for joining this webcast from Miami.
Did you know that an estimated 80% of a person’s sun damage occurs before the age of 18? If you have kids that means you need to give them extra protection when they’re outdoors in the sun.
Joining me now today to discuss sun care for children are two dermatologists from the University of Miami. To my right is Dr. Mariano Busso, Dr. Busso, thank you for joining us; and Dr. Steven Shapiro to my left, also from the University of Miami.
Now you folks are in the sun capital of Miami. You must see a lot of patients who have sunburns and need sun protection. Let’s talk a little bit about kids under six months of age. What kind of protection do they need?
MARIANO BUSSO, MD: Actually, I would like to change the name of the state… they should make it the sun protection state.
Under six months of age, of course has to avoid the sun completely, carry an umbrella, wear protective clothing. Remember the clothing has to be tightly woven clothing, that means that the sun cannot go through the clothing. If you want to know whether it does or not, just put the cloth against the sun, if you see it shining through, it’s not protective; wear a wide brimmed hat and a sunscreen.
There was some controversy whether to apply or not to apply sunscreen under six months of age, because there was a concern that babies would not be able to produce enough Vitamin D, but that has been solved and that hasn’t been shown to be a problem, so it’s safe to apply sunscreen on the baby. I would certainly try not to apply sunscreen that is alcohol based, just to make sure it doesn’t irritate the skin.
STEVEN SHAPIRO, MD: Actually, as a parent of a six month old, I think it’s also great to keep plenty of water out there as well because they could become dehydrated very, very easily. That’s one of the reasons why it’s probably better if they’re not out there to begin with, too.
SUSAN CINGARI: What about strollers, when you put babies in strollers? A lot of parents take their kids out in strollers. If they have an overhead hang, does it protect the baby under six months from sunburn?
STEVEN SHAPIRO, MD: Again, as an experience parent and a dermatologist, I understand that shade provides about 50% protection from the sun. So I tell people one hour under an umbrella is the equivalent of thirty minutes of direct sunlight. So when we’re talking about a baby less than six months old, that’s not 100% protection, either.
SUSAN CINGARI: So if we take our children to the beach, you know we‘ve got the summer coming up, what should we do for children under six months? What should we make sure to make them not get a sunburn?
MARIANO BUSSO, MD: You should always carry an umbrella, and actually apply a sunscreen…
SUSAN CINGARI: What about for children over six months old? Tips for older children?
STEVEN SHAPIRO, MD: We also happen to have a two year old, so what we did is we started very, very early, the moment he started to go outside. We always applied sunscreen as a rule before he left the house. And as most parents will know, it was very, very easy at the beginning, and then you hit the terrible twos and it becomes a little bit more difficult. What I found with time is that if you break the rule once, it’s more easy to break the rule again, so that we tell him it has to be done that way.
When we dress him in the morning, that’s when we put the sunscreen on, because usually they’re lying there, it’s a little bit easier. There are moments when he sees the sunscreen bottle, he associates that with going outside, he gets more excited, he wants to run, you have a little bit less time.
At those times we keep a spray sunscreen around, which is very quick to apply. In fact, what I found as a parent is that before I had children I used the creams and lotions, and now with two children, I tend to use more of a spray sunscreen, it’s just quicker, because once they’re ready to go, it’s very difficult to stop them.
I tell my patients that it’s important with children to get the sunscreen on before they even go outside, so it has a chance to dry and set first; to understand on a cloudy day that you get 70% to 80% of ultraviolet radiation, so you need to wear protection even on a cloudy day. I also tell people it’s the same sun walking down the street that it is at the beach, and most people associate water with the use of sunscreens and sunlight, but it’s important to understand that you’ll get your same sun in your backyard that you will at the beach. You don’t necessarily get the reflection off of the sand, but you still get that same intensity. You’re not always as hot, there may be a breeze in the area, but it’s still the same intensity of ultraviolet light. And make sure you cover the areas like the ears, make sure you cover the eyelids, those are common places to get skin cancer.
Once of the questions that people ask is about sunscreens burning. Try to find one that you like that doesn’t irritate, and each person is a little bit different when it comes to irritation. There are some patients that actually use a lip sunscreen for the areas around the eyes so that their sunscreen can’t run into the eyes and can’t burn the eyes. That’s a tip that I learned from a dermatologist in California because they have that same sun that we had down here, it’s very strong.
SUSAN CINGARI: Now as a parent of a two year old, your baby probably squirms a lot, like most two year olds. What do you when you have to reapply the sunscreen and the child just will not sit still? How do you get the sunscreen on him?
STEVEN SHAPIRO, MD: Number one, I look for sunscreens that say they block UVA and UVB, and it’s best if they say “All Day” on the label. All Day means eight hours worth of protection, so that one application in the morning can get you through the day. If your sunscreen doesn’t say All Day, you have to reapply every two or three hours, so the best time to do it is right after the meltdown before the nap, or right when they wake up from their nap.
And try to get that nap indoors, if you can. A lot of people go to the beach for the entire day, they have the child nap right there. I tell people the middle part of the day is the strongest sun, so what you want to try to do is at the middle part of the day, move indoors, to have lunch indoors, try to get that nap in a covered environment, these are things that will help.
And as far as the sunscreen goes, if you make it a rule where it’s always applied and get into that routine, it’s much easier to stay with the routine. Once you introduce it later on in life, it’s been found that it’s much more difficult to get people into the routine of using sunscreen.
MARIANO BUSSO, MD: And it’s important that children imitate their parents. So if they see their parents applying sunscreen, they will do it again.
Here in Florida there’s a problem because PE is usually here at noontime, which is the hardest sun. So it’s also important to try to move that to a time when there’s not so much of a sun radiation.
Kids should have apply sunscreen before they leave home every day, because as we mentioned, most of the sun exposure will happen just with casual activities, walking down the park, not always when going to the beach. So every day, the sunscreen should be part of a routine.
STEVEN SHAPIRO, MD: What do you tell your patients about protective clothing?
MARIANO BUSSO, MD: I tell them it’s not so important the type of clothing, the color, just make sure that the sun does not shine through the clothing. Long sleeves, and of course here in Florida it’s a problem because it’s so hot, so sometimes it’s just better to stay under the shade, and not so much think that you’re having the protection that you don’t have.
STEVEN SHAPIRO, MD: I found, actually, a bathing suit that has sunscreen in it, so it’s something that’s newer, it’s in the category of protective clothing, but it’s something that they can use and then you don’t have to apply the sunscreen to as many areas, they’ve most of their body covered.
SUSAN CINGARI: Many parents put hats on their kids, those cute little hats that you wear, they look so cute. But do they really offer protection for the children?
STEVEN SHAPIRO, MD: A hat provides shade, and I mentioned before, shade is about 50% protection from the sun. In fact, a lot of patients who are active outdoors, even older patients, they feel that the hat alone is enough, it’s not enough. Shade is about an SPF of eight or about a 50% protection. We tell people you need a 15 minimum sunscreen, a 15 minimum has a 93% block from the sun, a 30 is a 98% block. So if you’re exposed to a stronger sun, or if you’re going to be out for longer periods of time, it’s better to get into the higher numbered sunscreens. So that hate alone is not enough. The hate has to be in combination with a good sunscreen.
SUSAN CINGARI: Now parents will take their kids out in the sun, they’ll come back, they’ll be bathing them, and then all of a sudden they’ll see a mole, they’re probably concerned. If you’re child has a mole, does it increase its risk of skin cancer, for either one of the doctors?
MARIANO BUSSO, MD: Number one, when babies are born, only a small percentage of them will have a mole. Those moles can turn into melanoma later on, those have a higher risk. So if you’re born with a mole, that mold is riskier than most that you can get later on in life. So with all moles we check for changes, and also moles give you a degree of risk in your future life.
One thing I see all the time with older patients is they have a mole or a sunspot that they’re concerned about. And they say, “Well, this is a sunspot, it’s due to the sun, but I’ve never been in the sun for the last ten years.” No, that’s not important. It was your original sun exposure, when you were a kid under 18, that counts the most. So you have to start early on to have better skin later on.
STEVEN SHAPIRO, MD: It’s also never too late to practice what we call the principles of sensible sun exposure. A lot of people will feel most of their sun damage is done as a child, they can’t change that, they still need to practice the principles of sensible sun exposure. Put that sunscreen on before you leave the house, give it a chance to dry and set first. Understand that during the day, the middle of the day is the strongest sun of the day, and you need to avoid the midday sun as much as possible. On a cloudy day, as we mentioned before, you get 70% to 80% of ultraviolet radiation, you need to limit that sun exposure, too, and wear your sunscreen at that time.
As far as moles go and what to look for, there are some important characteristics. As Dr. Busso mentioned, the moles that you’re born with have a slightly increased risk. Typically it’s after puberty, but we do see some melanomas before puberty, but typically, the real risk is after puberty.
The average mole has about a one or two hundred chance of changing. And when you talk about change, you need to look for changes in size, shape and color. Birthmarks have a slightly increased risk of that, although nobody knows exactly what that risk is.
As far as what to look for in a mole specifically, I tell people every month do a self-examination, be in front a full length mirror, a handheld mirror behind you, or have family members check your back and look for what we call the A B C and D’s of moles.
A stands for asymmetrical: you look at the mole, you draw a line down the center of it, if both sides of it were to be able to match up, then that’s symmetrical, that’s a sign of normal growth, that’s a sign that it’s benign.
B stands for border regularity, and that talks about irregular growth going out; and I tell people if it has a notch in the border, it looks like someone took a bit out of one edge, that irregular growth pattern going out is a sign that it could be a skin cancer.
C stands for variation in color. If it’s multiple colors within the same mole, that should be brought to our attention as well. The average mole has a uniform color throughout. And D, of course, stands for diameter greater than six millimeters or greater than the head of a pencil erase, that gives you a rough idea what to look for. If it’s one millimeter, it’s got a regular border going all the way around, it doesn’t change from month to month, those are all signs that it’s benign. Still, once a year you should have a skin examination done by a dermatologist, and what a lot of us do is we look at the moles, we measure them, and we try to follow them for change.
MARIANO BUSSO, MD: Also, it’s very important that moles can be seen on any place on the surface of the skin, so we have to perform a full skin exam. That will include the scalp, inside the mouth, in between the buttocks, in between the toe webs. Moles can be seen anywhere, and by the time we see them on those places usually it’s late. So have someone check for them, or like Dr. Shapiro said, use a wall mounted mirror and a handheld mirror and with that you should be able to check every single spot on your skin.
SUSAN CINGARI: Dr. Busso, Dr. Shapiro, thank you so much. That’s some great information for parents and their kids.