By Patricia McAdams, Staff Writer, Nevus Outreach
Dr. Harper Price
Sunscreen is extremely important for outdoor activities, like swimming
Harper Price, MD, pediatric dermatologist at Phoenix Children’s Hospital, in Arizona, cares for children with a range of genetic and congenital skin conditions including large congenital melanocytic nevi (CMN). One central focus of her caregiving role relates to keeping her kids safe in the sun.
Price attended the 2012 Nevus Outreach Conference in Texas this July, where she spoke to families on a variety of topics — including sun protection. In fact, families raised a number of questions on this topic after the formal presentation.
Protecting kids from the sun
When asked which brand of sunscreen is best, Price said that the brand really doesn’t matter. “But choose a UVA and UVB broad spectrum physical blocker with zinc and titanium, she says. “And SPF should be 30 or higher. What matters most is if your child will use it,” she says, adding that it’s important to find something that feels good to them. She tends to recommend brands like Vanicream for infants and toddlers and Neutrogena for older children and teens.
Price pointed out the need for gobs of sunscreen — think “almost a golf ball size amount of lotion,” she says. And apply it every 90 minutes or so.” Reapplication is something many people just don’t do or forget about—that’s why people are still getting sunburn using sun block.
While Price prefers lotions and creams, sunscreens are available as sprays, as well, though she has reservations about these because of inhalation issues. “Inhalation make me nervous and I am not a nervous person.” Also, it is difficult to apply enough of the sprays on the skin (especially on windy days at the beach), so it is best to spray into your hands and rub onto the skin.
All things considered, though, clothing is more important than sunscreens in protecting kids from the sun. “You don’t need sunscreen under sun protective clothing,” she says, adding that there is a Rit dye product — called Rit Sun Guard Laundry Treatment UV Protectant — that you can wash your clothes in to boost their sun shielding.
Price also talked about the importance of Vitamin D for overall health and the necessity to supplement this vitamin in our diets. While sunshine is a good source of Vitamin D, we cannot get enough Vitamin D in 10 minutes a day in the sun, she says, nor do we recommend routine sun exposure to increase Vitamin D levels. The use of sunscreen blocks the sun’s rays, too. Price urges families to have their levels checked by their physicians and to follow your doctors’ guidelines in taking this supplement. Generally, 400 International Units (IU) of Vitamin D is the recommended daily dosage for children but more may be needed if your child is deficient.
Importantly, most melanomas arising in CMN are not likely caused by the sun. These appear to arise deep in the skin. To catch melanoma early, you want to be ever watchful.
One of the best ways to check for a melanoma is by routine palpation (feeling your child’s skin for lumps and bumps), Price says. “We tend to feel nevi a lot,” she says. In general, a new hard lump under the skin should prompt you to see your dermatologist.
Another good way to monitor possible changes in nevi is visually through photography and looking closely at patterns and how they may change over time. Physicians often use dermoscopes (also called “dermlites”) that magnify pigment patterns difficult to see with naked eye. Finally, biopsy suspicious areas.
According to Price, management of children with CMN is best individualized, as everyone is unique. She described several procedures for removing a nevus, if that were a family’s choice. She points out, however, that you cannot reduce the risk of melanoma to zero by removing a nevus, though there is a trend toward lower incidence of melanoma in individuals who have removed their nevus.
In addition to caring for the physical needs of a child, parents and physicians care about overall quality of life issues as well. Price shared a few studies that had been published in recent years related to social aspects of having a nevus. While these studies are somewhat sparse, they tend to report similar findings:
Many people disliked the social reaction to their skin lesions and reduced their social activities accordingly. And patients and their families felt that having a scar was more socially acceptable than having a nevus. In fact, about 75 percent of patients who had their nevus removed, were satisfied with the removal.
Much support can be gleaned from having a team of professionals caring for a child with a nevus, Price says. She encourages families to have a primary care physician, pediatrician, dermatologist, radiologist, pathologist, neurologist, surgeon, and psychologist all looking after their child.
“There is a lack of information in the literature about what it’s really like for children to live with a nevus, but blogs, meetings, and online support groups can make a big difference in their lives.”
She calls special attention to Camp Discovery, a free camp supported by the American Academy of Dermatology, for the countless children with more than 3,000 chronic skin conditions. According to their mission statement, Camp Discovery is “Where we learn the true meaning of strength and courage and where smiles, hugs, and laughter give hope to us all.” “Lots of kids with nevi attend this camp and they just love it.”