Ask EP: Sunscreen Use in Children

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Q:  We’re going away to the Caribbean with our 2 year old and I want to know if it’s safe to use sunscreen on him.  I was told that sunscreen has been linked with an increase in cancer, but also know of the very strong link between sun and types of skin cancer.  Which is it?

-          Brian L.

A:  First let me say that you are not alone in worrying about sunscreen.  Many parents do have concerns over what the ingredients are and how they affect their child, and it seems as though these concerns are not unfounded.  There have been several studies that have found correlational relationships between certain types of skin cancer and the use of sunscreens, raising the question of how much good they’re actually doing.  However, as with all research, there are other factors that need to be taken into account, and in this case, a group of researchers hypothesized that these relationships may be due to a third variable, namely the amount of time spent in the sun.  Philippe Autier and colleagues examined the amount of time spent in the sun as a product of the use and strength of sunscreen given to individuals on vacation.  Surely enough, they found a positive, linear relationship between strength of sunscreen and time spent in the sun; it seems people feel that by using sunscreen they can justify spending much more time in the sun and that this is the factor that may influence the findings pertaining to increased types of cancer and sunscreen use.  And in fact, one randomized, controlled study did control for the amount of time spent in the sun and the effectiveness of sunscreen in Queensland, Australia in a 4 ½ year follow-up of over 1000 participants.  The authors found no negative effects of daily sunscreen use when time in sun was controlled for, though interestingly they only found protective effects of sunscreen in one type of skin cancer.

Given the evidence, it would seem the concern with respect to sunscreen and cancer has more to do with the time spent in the sun then the use of sunscreen.  Thus, if you are careful about the time spent, your concerns with respect to cancer can be put to rest.  However, that does not negate what many people worry about, namely the ingredients in many sunscreens.  In one study, the inorganic ingredient titanium dioxide was found to cause DNA damage both in vitro and in human cells, raising concern about its use in sunscreens.  However, there are other organic and natural sunscreens that use zinc dioxide which eliminate that concern (and in mild dosage, it may not be a concern for you) – in fact, you can check out the Environmental Working Group’s database ranking sun protection items based on the ingredients and the risk for cancer.  Furthermore, if you don’t want to use sunscreen, you can still ensure your children remain safe by using hats, keeping them in the shade, and having them wear lightweight clothing that still covers their skin.  Especially if this is only a vacation where their exposure to strong sun will be short term in nature.  But enjoy and have fun regardless of what you choose to do!

 

Sources:

Autier P, et al. Sunscreen use and duration of sun-exposure: a double-blind, randomized trial. JNCI 1999; 91: 1304-9.

Beitner H, Norell SE, Ringborg U, Wennersten G, Mattson B. Malignant melanoma: aetiological importance of individual pigmentation and sun exposure.  British Journal of Dermatology 1990; 122: 43-51.

Dunford R, Salinaro A, Cai L, Serpone N, Horikoshi S, Hidaka H, Knowland J. Chemical oxidation and DNA damage catalysed by inorganic sunscreen ingredients. FEBS Letters 1997; 418: 87-90.

Green A, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomized controlled trial.  The Lancet 1999; 354: 723-729.

Luther H, et al. Increase of melanocytic nevus counts in children during 5 years of follow-up and analysis of associated factors.  Archives of Dermatology 1996; 132: 1473-8.

 

sunscreen, ultra violet light, uv protection, sun protection, cancer, hats, clothing, organic, inorganic, shade, melanoma

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Comments

  1. Monica says

    Interesting note about Titanium dioxide, also worrying as the stuff is everywhere – toothpaste, lip gloss, etc. Is Dunfort et al. the reference for that? Thanks!

    • says

      Dunfort et al. is indeed the reference for that. It is worrying, but I think like most things, problems are more likely with overuse than occasional use.

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