A 13-year-old girl is brought to the office for evaluation of sunburn. She and her family just returned from a 4-day vacation to the Bahamas. While there, the patient applied sun protection factor 50 sunscreen every morning about 30 minutes before walking to the beach. She specifically bought "water-resistant" sunscreen so that she could swim. After 2 days, however, she developed painful redness on her face and shoulders that has started to peel. The patient is otherwise healthy and takes no daily medications. Her parents say that "everybody tans easily" in their family, and there is no family history of skin cancer. Physical examination shows a well-appearing adolescent with tender, blanching erythema on the face, shoulders, and arms. There is no edema or vesicles. Appropriate supportive care measures for treatment of her sunburn are discussed with the family. Which of the following is the most appropriate preventive recommendation to provide this patient?
Sun-protective measures | |
Exposure |
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Sunscreen |
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Clothing |
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SPF = sun protection factor. | |
Sunburn is an inflammatory response to excessive exposure to ultraviolet (UV) radiation. Regardless of skin type, additional risks from UV exposure include photoaging and skin cancer. Therefore, all patients should be counseled about the carcinogenic effects of UV exposure and the benefits of photoprotection.
Sun avoidance is the best method of photoprotection, especially during peak hours of UV intensity, from 10:00 AM to 4:00 PM (Choice G). If it is impractical to stay indoors, broad-spectrum sunscreens with sun protection factor (SPF) ≥30 should be used. Sunscreen should be applied liberally 15-30 minutes before sun exposure, as this patient does, to allow the formation of a protective film on the skin, and reapplied at least every 2 hours (Choice A). Even if products are labeled as "water-resistant," reapplication after swimming is necessary as sunscreen is washed off with swimming and sweating (Choice B).
Sunscreen alone is inadequate. Dark colors, long sleeves, and broad-brim hats are recommended to block sun exposure. In addition, cloud coverage does not block UV rays, which can be reflected off water, sand, snow, and concrete. As a result, patients can burn in the shade or while skiing in the winter.
(Choice C) Sunscreens with SPF >50 provide a negligible increase in UV protection as compared to sunscreens with SPF 30-50 and are not routinely recommended. This patient already uses an SPF 50 sunscreen and would not likely benefit from an increased SPF product.
(Choice D) This patient correctly applies an appropriately rated SPF sunscreen 30 minutes prior to sun exposure. However, reinforcing her current regimen is inappropriate as she developed sunburn and does not reapply sunscreen.
(Choice E) "Pre-tanning" with tanning beds can increase skin pigmentation but also increase UV radiation exposure. As a result, it does not protect against sunburn and in adolescence is associated with a 75% increase in melanoma.
(Choice H) Protective clothing is helpful in blocking sun exposure, but dark-colored fabrics are preferred over light-colored fabrics. Darker fabrics offer greater UV protection as the rays cannot penetrate the fabric as well.
Educational objective:
Sun avoidance is the best form of photoprotection. Sunscreen with sun protection factor ≥30 should be applied 15-30 minutes prior to sun exposure and reapplied every 2 hours as well as immediately after swimming.