AAP National Conference: Everyone under the sun should protect their skin

Solar radiation and sun damage at any age go on the “permanent record” of the skin, making sun protection a lifetime precaution. Pediatricians also need to be diligent to look for some of the rare but more serious diseases associated with sun exposure that can affect their patients.

This exhortation came from Susan Boika, M.D., FAAP, associate professor of dermatology, University of California San Diego School of Medicine, Rady Children's Specialists.

“It doesn’t matter what color your skin is, everyone under the sun needs sun protection. The oldest patient I ever saw with a skin cancer was a dentist, and at the age of 102, he got his first skin cancer,” she said in the Focused Topic session Monday “It’s Not Just About Tanning: Sun Exposure Disorders and Sun Protection.”

She added, “If I had my way, everyone would have a Beatles haircut — long over the ears, down the forehead with bangs and down the back of your neck.”

Dr. Boiko emphasized the importance of using defensive measures when in the sun to protect against ultraviolet A and B rays, including wearing protective clothing, sunglasses and the right amount of sunscreen. She recommended 1 ounce of sunscreen, the equivalent of a shot glass, with SPF 50, reapplied every two hours.

She has even written a sun protection rap song that she performed as reminder for her patients with the following chorus, “Slip, slop, slap, wrap” – slip on a sleeved shirt, slop on some sunscreen, slap on a hat that covers your ears and wrap up in some sunglasses.

In addition to counseling for sun protection and making patients and families aware of the UV Index scale, Dr. Boiko, a member of the AAP Section on Dermatology, encouraged pediatricians to be vigilant about screening for basal cell carcinoma, which is the most common skin cancer, squamous cell and melanoma. She also suggested being familiar with the signs of phytophotodermatitis, lupus and xeroderma pitmentosum.

Phytophotodermatitis, or “lime disease,” can cause inflamed skin or blistering when chemical furocoumarins, found in citrus peels or celery, get on the skin, which then is exposed to prolonged UV rays.    

Patients with lupus may have elevated photosensitivity so Dr. Boiko encouraged pediatricians to be alert to possible signs. Lupus can present as a butterfly rash, circular rings in newborns or young children, red patches, small scabs that will not heal or scars in the ear.

The rare disorder xeroderma pitmentosum is inherited and as result of a defective DNA repair process increases a child’s sensitivity to UV rays and to developing skin cancers exponentially.

“These kids are so sensitive that even a little exposure of UV light to their tongues can give them skin cancer on their tongues,” Dr. Boiko said. “These children will need a lot of resources.”