Melanoma Is on the Rise in Children

Melanoma is on the rise in children. Learn how to protect your children in the sun while still having fun.

Classic beach picture

There are few sights cuter than a toddler waddling her way along the beach.

There are few sights sadder than a toddler with a raging sunburn, particularly to the eyes of a dermatologist. That’s because we know how damaging even one sunburn can be to a child. In fact, just one blistering sunburn in childhood will more than double a person’s chances of developing melanoma later in life. 

An infant’s skin has very little melanin (the pigment that gives the skin its color) which makes them especially vulnerable to sun damage. This is why babies 6 months old and younger should be kept out of the sun completely. Sunscreen is too harsh for their delicate infant skin.

Why is sun protection so important? Because we know that sun damage causes skin cancer in children, adolescents, and adults. While melanoma, the deadliest form of skin cancer, is still rare in children, a new report published in April 2013, shows that it is actually rising in children. Researchers from Washington University and Harvard have found that the incidence of childhood and adolescent melanoma has increased an average of 2% per year from 1973 to 2009. Moreover, melanoma is nine times more common between the ages of 10 and 20 than it is between birth and 10 years. So, protecting your child from the sun will help protect her from skin cancer throughout her life.

Here’s how to keep your child safe while still having fun in the sun:

  • Apply broad-spectrum sunscreen of SPF 30 to 50 about 20 minutes before heading outdoors. Reapply every 2 to 4 hours, or more frequently if your child is sweating or swimming. Don’t forget to apply it to their ears, neck, hairline, hands, and feet. Do not use sunscreen on children 6 months old and younger.
  • Cover up: Your child won’t get a sunburn through clothing. So wearing lightweight protective clothing such as long-sleeved tops and pants is an excellent way to prevent sun damage. Consider buying a protective baby suit like this one or a sun-protective rash guard clothing like this long-sleeved top for toddlers.
  • Hats & Sunglasses: They’re not just fashion accessories; they’re sun-protective.
  • Seek the shade: Remember that the sun is strongest between 10am and 4pm, so limiting your child’s time outdoors during those hours will help. If that’s not possible, then be sure to sneak in shade breaks throughout the day.

Skincancer.org offers more helpful information about sun protection for infants, babies, and toddlers.

One more thing…. Have you gotten naked for someone you love yet? May is Melanoma Awareness Month which means it’s time to get naked and do a skin exam. Please help spread the word by posting about this and about your skin check! Use the hashtag #GNFSYL on Twitter.

Photo credit: FCC, Stevie Lee

Should I Get a Base Tan Before Vacation?

I just got back from a conference in Hawaii. Did I get a base tan first? No. Why? Because it does more harm than good.

Tanned skin is damaged skin. Even if the base tan helps prevent sunburn, you had to damage your skin to get that tan in the first place. Using artificial tanning to rush a tan before you get on your flight can be even more damaging.

Go to Hawaii, swim with the dolphins, lounge by the pool. Cover up, wear sunscreen, sit in the shade. Your skin needs a vacation too.

Photo: J Benabio, MD

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Why Do Sunburns Itch?

Have you ever had a sunburn? First it hurts. Then it itches. And itches. And itches.

Why is that?

Sunburn is caused by ultraviolet (UV) radiation damage to your skin. Too much UV damages your skin cell’s DNA, and your immune system responds by killing off the bad cells. Because UV radiation doesn’t penetrate (unlike X-rays for example), it damages only the surface layer of your skin. This outermost layer happens to be loaded with special nerve fibers called C-fibers which are responsible for itch.

Itch is a mechanism to protect us against insects and other minor injuries that aren’t significant enough to register as pain. It’s our skin’s way of saying; “Hey, there’s a bug on us, get it off!” Because the damage from sunburns happens in this same surface layer, these C-fiber nerves fire furiously until the skin is healed.

Here’s how to soothe sunburn itch:

  • Try a soothing lotion such as Eucerin Calming Lotion. You can even keep it in the refrigerator for a few hours before applying it for cool, soothing relief.
  • Lukewarm baths with colloidal oatmeal can also sooth and heal sunburned skin.
  • Many people also like aloe for its anti-inflammatory and soothing properties.
  • Avoid topical numbing sprays with “cane” in them. Allergies to these topical anesthetics is common, and the last thing you need is to add a raging allergic dermatitis to an already itchy sunburn — it’s an itch of Biblical proportion.

Photo: Kelly Sue, Flickr

Sunscreens Cause Acne! (and Other Summer Acne Facts!)

With blonde hair and big blue eyes, she looked like a young Betty Draper from Mad Men. My patient, Julie, had been faithfully treating her acne for months. Just when she was starting to clear (in time for her senior photos), wham! Red dots cropped up over her forehead and cheeks. What went wrong? Summertime.

July can be the cruelest month for acne. Acne on the chest and back (bacne) and big, red pimples on your face can make going to the beach an embarrassing experience. Here are a few acne facts for summer:

1. Although there is some suggestion that sun can help acne, its effect varies and sun often makes acne worse. (Bacne + sunburn = bacne burn. Not good).

2. Retinoinds such as topical Retin-A, tretinoin, Differin, Tazorac, Ziana, Atralin, and Accutane all remove the outer layer of skin, leaving you more susceptible to a bad sunburn. Benzoyl peroxide and salicylic acid also peel the outer layer of skin, making you more sensitive.

3. Oral antibiotics such as doxycycline, minocycline, tetracycline, and sulfa antibiotics predispose you to a  painful pink burn on your nose, hands, and arms called a phototoxic rash; I see patients with this all summer long. The pink splotches can take weeks to fade and sting every time you’re in the sun.

4. Sunscreens can cause acne. It’s a cruel fact. Often the best sunscreens such as zinc and titanium, or water resistant sunscreens are the most likely to worsen acne. In order to be effective, sunscreens have to coat your skin which also clogs your pores.

Here are 5 tips to help keep you acne-clear this summer:

1. Remember that sun exposure is not a good way to clear up acne; most people get far more sun that what is helpful and just the right amount of sun to make it worse.

2. If you have fair or sensitive skin and are taking oral antibiotics for acne, then discuss with your physician if you are taking the best antibiotic during summer. Some patients take a break from antibiotics during summer months or switch to antibiotics that are less sun sensitizing.

3. Find ways to protect against the sun other than sunscreen: avoid the sun between 10 AM and 2 PM, wear a big hat (demonstrated here) and cover up.

4. When you need sunscreen, consider products designed for your face which are less oily or less likely to worsen acne such as: Neutrogena Ultra-sheer Dry Touch, Eucerin Facial Moisturizer with SPF 30, La Roche-Posay Antihelios Tinted Cream, or Proactiv’s Daily Protection Plus Sunscreen.

5. Avoid overusing scrubs, toners and slamming face-first into the beach; the added exfoliation will only make risk of sunburn worse.

Just hang-on, winter will be here again before you know it. Does your acne get worse in summer? What sunscreen do you use.

Photo: Foreversouls (flickr). Patient identity changed.

Where Are You More Likely To Sunburn: Beach Or Mountains?

While vacationing in Idaho and Montana last week (blissfully off the grid), I experienced something beautiful: altitude. At 6,260 feet Stanley, Idaho is a mile higher than my home in San Diego. The skies there were a brilliant blue. There was daylight well after 10 PM. The mornings were a chilly 35 degrees. And I got sunburned.

How can this be? Montana is over 1,000 miles north of San Diego. Shouldn’t the sun be stronger down here?

Several things determine the sun’s intensity. The closer to the equator you are, the more intense the sun’s rays. But also, the higher up you are, the more intense the sun’s rays. Your UV exposure increases by 10% for every 3,280 feet in altitude; at 6,000 to 8,000 feet in elevation, you’re exposed to 25% more ultraviolet radiation than at sea level.

Also, snow (which fell during our mid-June trip) is an efficient reflector of sunlight. When skiing or hiking in snow, 80-90% of UV light is reflected at you, dramatically increasing your sun exposure. Grass in comparison reflects only about 3% of sunlight.

Water, especially when still, also reflects sunlight. Still lakes, including the beautiful Yellowstone Lake pictured above, can reflect up to 100% of UV light (hence the term mirrored lake), doubling your UV exposure.

So although you might feel hot lying on the beach in June in Southern California, you might be more vulnerable to sunburn on a chilly hike in Yellowstone after a June snowstorm, which is exactly what happened to me. (Hence the Stetson later in the trip…)

Photos: Madsit, Stanley, ID (top) Purticortico Yellowstone Lake, WY (middle) Dermdoc White Bird, ID (bottom).