Sun Protection for the Pediatric Patient Cassandra Beard, OMS IV A.T. Still University School of Osteopathic Medicine in Arizona UV Radiation

 Sun is primarily a UVA source  Only ~5% of UVB rays reach the Earth’s surface

 UVB Radiation  1000 x more damaging than UVA radiation in regards to causing sunburns

 UVA Radiation  Penetrates deeper, plays key role in photoaging

 Risk of skin damage highest when UVB:UVA ratio is high  10am and 3pm

 Cumulative lifetime sun exposure increases risk for Squamous Cell Carcinoma

 Intense, intermittent exposure (e.g. sunburn) in childhood increases risk for Basal Cell Carcinoma and Melanoma Individual Susceptibility

An increased susceptibility to sunburn is also a marker for increased risk of melanoma and nonmelanoma skin cancers

Darker skin types (5 & 6) typically require higher doses of UV radiation to develop a visible erythema

Physiology of Damage

 Sunburn: vasodilation, endothelial cell activation, and release of inflammatory mediators

 Photoaging: production of Reactive Oxygen Species (ROS) with UVA penetration into the deep dermis  degradation of dermal collagen with imperfect repair

 Melanoma: UVB-mediated DNA damage  If the damage is not naturally repaired by the body malignant transformation

Risk in Pediatric Population  Studies demonstrate increased risk with increased number of melanocytic nevi and with the occurrence of sunburns in childhood  Sunburns in childhood and adolescence  significant increased risk for developing melanoma  Sunburns in adulthood do NOT contribute to risk elevation for melanoma  Total number of melanocytic nevi= most important risk factor for cutaneous melanoma  Higher nevus count associated with increased sun exposure in childhood

Limitation of Environmental Risk Factors-Pediatric Specific

 Sun Protection  Avoidance of Sun Exposure  Protective Clothing, Hats, Sunglasses  Sunscreen/Sunblock  Education about the dangers of artificial UV radiation  Tanning beds  Chronic PUVA (psoralen + UVA radiation in treatment of psoriasis, eczema, vitiligo, ect) Avoidance of Sun

 Unprotected exposure of 30 minutes or less per day  Limited amounts of sun exposure promotes the natural production of Vitamin D within the body

 Most experts recommend acquiring Vitamin D via nutritional supplementation and diet rather than through sun exposure

 Between 10am – 3pm, more UVB radiation penetrates the atmosphere increased exposure to dangerous radiation Use of Protective Clothing

 Tightly woven fabrics  Sunglasses and hat protect the eyes, face, and sometimes the back of the neck

 Specialized laundry aids  Added to laundry to provide some level of SPF to clothing for some specified number of washings

 Specialized clothing that promotes sun protection is available Sunscreen and Sunblock

 Organic Filters absorb UV radiation and convert it to a negligible amount of heat  E.g. oxybenzone, avobenzone

 Inorganic Filters reflect and scatter UV light.  Titazium or zinc oxide  Less likely to irritate baby’s sensitive skin

 “Broad Spectrum” sunscreens protect against UVA and UVB radiation  SPF quantifies protection of UVB radiation, but not UVA

 Increased SPF= Increased “stickiness” factor= Decreased compliance  No evidence supporting benefits from using suncreen with SPF greater than 50

 “Water Resistant” or “Very Water Resistant” means that SPF is maintained after 40 or 80 minutes of activity in water, respectively Octinoxate (cinnamate), Homosalate (salicylate), Avobenzone Octisalate (salicylate), Octisalate (salicylate), Homosalate (salicylate) Zinc Oxide Oxybenzone (benzophenone), Octinoxate (cinnamate) Avobenzone Octisalate (salicylate) Octocrylene

Avobenzone Homosalate (salicylate) Titanium dioxide Octisalate (salicylate) Zinc Oxide Octocrylene Oxybenzone (benzophenone)

Sunscreen Recommendations

 All individuals, regardless of skin phenotype, are susceptible to adverse effects of UV radiation

 AAD Recommendations  SPF 30+ with all outdoor activities  “Broad Spectrum” protection  “Water Resisitant” or “Very Water Resistant”

 AAP recommends avoiding sunscreens in infants less than 6 months, unless adequate shade and clothing are unavailable

 Oil-based emulsions of inorganic filters are preferred to organic filters for infants and children Resources

 UpToDate  Bologna, J. L., Schaffer, J. V., M.D., & Jorizzo, J. L., M.D. (2012). Dermatology(3rd ed., Vol. 1) [3]. Retrieved April 27, 2016, from https://www-clinicalkey- com.p.atsu.edu/#!/content/book/3-s2.0- B9780723435716001652