A tan is a sign of skin damage.
When the skin is exposed to UV light, the UV rays affect the DNA of epidermal cells and dermal fibroblasts, resulting in genotoxic and oxidative effects. In response, a protective mechanism in the skin is called into action where the existing melanin in the skin oxidizes and melanocytes produce new melanin, resulting in tan. The level of susceptibility will vary depending on the child’s skin type and how quickly they sunburn as well as how easily they tan. Children are even more susceptible than adults to this DNA-damaging effect due to lower levels of protective melanin present in the skin (melanocytes do not become fully functional until into the 2nd year of life), a thinner stratum corneum, and a higher surface area: body mass ratio.
A recent study out of England looked at healthy Caucasian babies suggesting that UVR-induced skin changes and associated photodamage can begin as early as the first summer of life before melanocytes have become fully functional. Additionally, it is believed that prior to the age of 18 years, children receive much of their lifetime-accumulated sun exposure. Chronic UV light exposure is associated with nonmelanoma skin cancer and head/neck melanomas. Several epidemiologic studies also suggest that the skin of young children may be especially vulnerable to early intense UV light exposure that leads to blistering sunburns and has been associated with trunk melanomas.
Increasingly, the skin is being recognized as playing an important role in the body’s immune response. Exposure to UV light can modulate this immune response and result in a level of immunosuppression. Transgenic mice studies have demonstrated that exposure to solar-simulated radiation in the neonatal period can reduce epidermal Langerhans cells and potentially compromise skin immune system development. Whether infants and young children are similarly susceptible is not clear at this point, but further study is needed in this area.
What advice should I be giving parents regarding sun protection for their children?
We have made progress in educating the public about sun exposure risks. However, sun protection practices for children remain suboptimal. On any summer weekend in the United States, 7% to 13% of American children become sunburned, and the incidence for the summer season ranges from 29% to 83%. Remember that children of any skin type can sunburn if the UV light dose is high enough. Recommendations for sun protection are available from the AAP, American Academy of Dermatology (AAD), and the American Cancer Society (ACS) and they include:
· Sun avoidance: Avoiding suntanning and sunburn is especially necessary for infants less than 6 months of age. Keep babies away from direct sun exposure. For older infants and young children, time outdoor activities to avoid periods of peak sun exposure. Use lightweight but tightly woven clothing and hats to cover skin and provide shaded play areas. Extra caution should also be used around reflective surfaces such as water, snow, and sand that can reflect up to 85% of the UV light
· Apply and reapply sunscreen: In infants and young children, use sunscreens that have the lowest possibility for skin penetration, irritation, and allergy. Since babies often rub their eyes and put their hands in their mouths, exposure through this route must also be considered. For children 6 months of age and younger, the AAP recommends sun avoidance but states that sunscreen may be applied to small areas of skin uncovered by clothing and hats
Studies have demonstrated that sunscreens containing only nano-scale titanium dioxide and/or zinc oxide filters do not penetrate beyond the stratum corneum in adult or infant skin. These same sunscreens may also be the mildest to eyes and safest for oral exposure. Oil-based emulsion formulations of these inorganic sun filters seem to be the safest forms for very young children and those with particularly sensitive skin since they tend to contain fewer fillers, fragrances, photostabilizers, and preservatives.
We at Private Label Skincare Florida have made progress spreading the news that sun protection is necessary for children. However, we still have a long way to go in implementing these practices and establishing them as health habits.