Skin cancer

Sunscreen: Like a seatbelt, everyone needs to put it on

The new labels for sunscreen, required by the Food and Drug Administration.
The new labels for sunscreen, required by the Food and Drug Administration.

When Dr. Ana Duarte became aware of a policy in many schools that bans students from putting sunscreen on themselves without a doctor’s note, she couldn’t believe it.

The only two states that allow students to apply their own sunscreen during the school day are California and New York. All other 48 states have some type of restriction: not allowing teachers, faculty or staff to apply sunscreen to children because of potential allergic reactions; only allowing the school nurse to apply sunscreen to children; or banning sunscreen use during school hours altogether.

“I was like, ‘What?’ ’’ said Duarte, division director of dermatology for Miami Children’s Hospital and founder and president of the Children’s Skin Center, P.A. “It is not a prescription medication, so to have to have a doctor’s note is not really practical.”

The American Medical Association adopted a resolution in June that “supports the exemption of sunscreen from over-the-counter medication possession bans in schools and encourages all schools to allow students to bring and possess sunscreen without restriction.”

According to the Centers for Disease Control and Prevention, just a few serious sunburns can increase a child’s risk of skin cancer. The CDC encourages children to stay in the shade as much as possible, wear protective clothing such as hats and sunglasses and, most importantly, wear sunscreen.

Motivated to help spread the word, Duarte became a consultant to the makers of Coppertone and its Making the Sunscreen Grade campaign, which raises awareness of sun protection during the school year. The campaign provides a downloadable letter that parents can print out to get the conversation started in schools about the need for a sun protection policy.

“In the state of Florida, the Sunshine State, it would be great for our kids to be adequately protected throughout the school year,” Duarte said. “Right now in most states, every district has its own policy of what they will allow, so the main thing is to find out what the issues are because a lot of parents don’t know about it or they assume it is OK.”

The Food and Drug Administration released new rules governing sunscreen labeling, which have been in effect since December. Now, sunscreens must pass a “broad spectrum” test, which measures a product’s protection from ultraviolet A and B rays.

Sunscreens are not able to reduce the risk of skin cancer unless they are considered broad spectrum with an SPF value of 15 or higher. Sunscreens with an SPF from 2 to 14 can claim to help prevent sunburn, but not skin cancer. The FDA also states that sunscreen manufacturers cannot claim to be waterproof or sweatproof because it “overstates their effectiveness.” And when it comes to sunscreen being water resistant, the front label must state whether the sunscreen is effective for 40 or 80 minutes.

“I tell my patients that they need to reapply sunscreen every two hours at a minimum, or more frequently, especially if sweating too much or swimming,” Duarte said.

Sunscreen containing zinc oxide and titanium dioxide is considered a “sunblock,” that is, it works instantly and acts as a shield against the sun. Other sunscreens need to be applied at least 20 minutes before sun exposure.

Another critical component to proper sunscreen protection: The right amount. For sunscreens to work best, children should cup their palm and completely fill it.

The Making the Sunscreen Grade campaign encourages parents to do the following: ask about school policy; promote sun-smart school environments; discuss sun protection at school meetings; evaluate shaded areas; find out the times schools have outdoor activities; teach children the importance of sun protection; and incorporate sun protection during daily activities.

The Skin Cancer Foundation says that one blistering sunburn in childhood more than doubles the chances of developing melanoma — the most aggressive and deadliest form of skin cancer — later in life. Melanoma affects one in 58 people.

For the last decade, skin cancer has been increasing about 2 percent each year, and one of the fastest-growing groups are 15- to 19-year-olds. Duarte says this could be due to the use of tanning beds and increasing sun exposure without protection.

“It is really important to get people to practice sun-savvy behaviors because we know it’s tough to get people to change habits,” Duarte said. “It is important to wear sunscreen. We are in a skin cancer epidemic and we need to change our mindset and realize that it is important.”

Although the FDA says that broad spectrum sunscreen with an SPF of 15 or higher can help minimize the risk of skin cancer, Duarte says that anything below SPF 30 is insufficient. She also says that SPF 100 may not be any better at preventing skin cancer, but she does not discourage patients from using a higher SPF.

“I just don’t want them to be overconfident just because it says SPF 100,” she said. “Follow the rules, and when you can, get out of the sun.”

From August to June, children spend at least seven hours a day in school, if not more. The sun’s peak hours are 10 a.m. to 4 p.m., which coincide with elementary, middle and high school hours.

For children with dark skin, Duarte says sunscreen is still a must. Although people with more melanin in their skin are naturally more protected from the sun, they are not immune to skin cancer. Ultraviolet radiation is a carcinogen — directly involved in causing cancer — and exposing skin to UV rays means exposing skin to a carcinogen.

“We need to change our mindset about the healthy tan,” Duarte said. “There is no such thing as a healthy tan, unless it is a fake tan from an artificial tanner.”

Sun exposure is cumulative, which means that every time a child is being exposed to it, they are increasing their chances of skin cancer later in life.

“Parents need to get involved with the school deal because kids spend a lot of time in school,” Duarte said. “We really need to be more careful. I take skin cancer off of every skin type, and every age group. The idea that it only occurs in very old and fair people is wrong. Sunscreen is like seatbelts: Everyone needs to put it on before they go out.”

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