Contributed by Dr. Jaime Friedman, M.D., F.A.A.P.
Does everybody need to wear sunscreen?
Something I get asked a lot is whether or not children with darker skin tones need to wear sunscreen at all. No matter what color your child’s skin is naturally, they need to wear sunscreen. Whether your child’s skin is pale with freckles, African-American or olive-toned all skin burns. Those with the palest skin-tones do burn more easily, but every shade of skin burns with sun exposure. Sadly, research shows that due to the mistaken belief that darker skin doesn’t burn, many forego sunscreen and ignore the early signs of skin cancer. This leads to poorer outcomes for those with darker skin and skin cancer.
Tanning does not protect skin from burns
Ultraviolet rays from the sun (and tanning beds) are responsible for skin color change. Any skin color change represents damage to the DNA in skin cells which over time causes different types of skin cancer. There is no such thing as a base-tan protecting you or your kids from getting burned. It may obscure the visible signs of the burn, but the damage is still there.
In fact 90% of skin cancer (basal cell, squamous cell and melanoma combined) is due to UV radiation. The deadliest form of skin cancer is melanoma, which usually develops in adulthood but has been diagnosed in people as young as their 20’s. The risk of melanoma increases every time you get a blistering sunburn as it only takes 5 sunburns as a teen to increase one’s risk of melanoma by 80%. Melanoma kills over 10,000 people yearly. If your teen or tween asks to use a tanning bed to get a base tan for summer, just say no!
Only certain types of UV rays damage the skin
There are several different types of UV rays, but there are only two that we worry about when it comes to skin damage:
- UVA–These rays penetrate deep into the skin causing damage in the subcutaneous tissue. They contribute to premature aging and wrinkles because of this damage. (Hint: wear UVA protection daily to prevent wrinkles)
- UVB–These rays cause more superficial damage to the outer layer of the skin, causing sunburns.
- UVC–These rays do not penetrate our atmosphere
The American Cancer Society, American Academy of Dermatology and the World Health Organization all agree that sun exposure is a major risk factor in developing skin cancer and sunscreen that blocks UV rays is the best protection.
Is sunscreen safer than getting burned?
Yes! Sunscreen is safe and necessary to protect your skin. There are many types of sunscreen available and lots of good and not-so-good information out there for all of them. Let’s break it down into 2 main categories:
- “Organic”/Mineral sunscreens: First let’s address the name. Many sunscreens marketed as “organic” are actually mineral sunscreens. Companies add the word organic as a marketing gimmick, that doesn’t mean they don’t work, just don’t be tricked into paying $30 for a bottle of sunscreen because it has the word organic on the bottle. These sunscreens contain a physical UV blocker, either zinc oxide or titanium dioxide. These are both inorganic compounds (non-carbon containing) that stay on the surface of the skin and absorb both UVA and UVB rays. They can be thick and leave the skin looking white but they work very well. Note that these sunscreens aren’t water/sweat resistant and can rub off easily. So if you’re spending the day at the pool or the beach, or your kids are rolling around in the grass, make sure you reapply frequently.
- Conventional sunscreens: You’re likely most familiar with these sunscreens, they have familiar names like Banana Boat, Coppertone and Hawaiian tropic. Some people call these sunscreens “chemical” sunscreens but that’s a misnomer as everything is a chemical, including the ingredients in “organic” sunscreens. Conventional sunscreens absorb into the skin and often include ingredients like oxybenzone and avobenzone. Oddly enough, these chemicals are organic (meaning they contain carbon) and block UVA and UVB rays without leaving a thick white residue. Because they absorb into the skin they rub-off less easily meaning they tend to stay on longer before they need to be reapplied (approximately 80 minutes).
Every summer the internet teems with information about the dangers of sunscreen, mostly because of limited and cherry picked evidence reported by the Environmental Working Group. The overwhelming consensus from scientists and dermatologists does not support the EWG findings as their information comes from data that is not reproduced or peer-reviewed.
A common claim is that the ingredients in conventional sunscreens cause cancer or are hormone disruptors. One of the most frequently cited studies involves oxybenzone, which is a synthetic estrogen. In this study oxybenzone was fed orally to rats and found to cause a whole host of problems. This study isn’t generalizable to humans for a number of reasons, including that rats aren’t great medical stand-ins for humans, the study involved a small number of rats, and the rats were fed large quantities of the chemical, instead of having it applied to the skin in quantities similar to what a human would use. One human study looked at hormone levels before and after usage and only minimal changes were found. The good news is we don’t eat sunscreen and we aren’t rats so the likelihood that oxybenzone truly presents a danger is pretty low. However, some people are allergic to oxybenzone so that would be a major reason to avoid it.
You may also hear about the ingredient retinyl palmitate which is an inactive ingredient in sunscreens, and also an active ingredient in anti-aging products, derived from Vitamin A. Again, a study in rats showed an increase in cancer due to large amounts of retinyl palmitate applied to the skin but this has not been reproduced in humans.
So what sunscreen should you buy for your family?
We’ve established that sunscreen is not only important for cancer prevention, but is safe to use. Here are the tips that I give to my parents in the office:
- Look for a product that is clearly labeled UVA and UVB protection, or broad spectrum. Make sure it is SPF (sun protection factor) 30-50, higher probably won’t add much more protection.
- Apply sunscreen at least 30 minutes before going out into the sun. Re-apply every 90 minutes, more often if you will be in the water.
- If you prefer a mineral sunscreen over a chemical sunscreen due to the above concerns, make sure your child is not wiping it off while swimming.
- I caution against sprays because their coverage is uneven and inhalation is not recommended.
- Don’t forget wide-brimmed hats and sunglasses
One last note to leave you with, the list of recommended sunscreens put out by the EWG frequently includes very expensive products that are cost-prohibitive. My advice from a risk:benefit ratio is to use the above list of recommendations and find a sunscreen you can afford, will be able use and you feel comfortable with.