By: Dr. Kelli H. Tapley
Good skin care should begin in infancy and continue throughout life. As children age, especially upon entering the hormone-riddled tween/teen years, their skin care needs change and the need to treat and prevent acne becomes as important as sun protection.
Step one is teaching parents to avoid sun exposure in their infants. Sun-related skin changes occurring as early as the first year of life may lead to melanoma and other forms of skin cancer later in life, according to a review in July 2011 issue of Pediatrics. The “best” sunscreen depends on patient age and other factors such as level of activity. But it doesn’t work if it’s not applied and re-applied frequently. The AAP does not endorse any sunscreen in children under six months, but it can be used as a last resort when exposure cannot be avoided.
The Environmental Working Group, an non-profit, non-partisan organization, publishes yearly reviews on the best sunscreens on its website. www.ewg.org Their recommendations are based on products that do not contain oxybenzone, retinyl palmitate, combination sunscreen and bug repellents and are not “spray on.” I advise parents to look for products that provide coverage from UVA and UVB rays and contain zinc oxide, avobenzone and Mexoryl SX. Some of my favorites are: CVS Baby Sun Lotion Broad Spectrum SPF 50, Aubrey Organics Natural Sun Screen Sensitive Skin Children (available at Whole Foods), Vanicream Sunscreen Sport (available on Amazon), Blue Lizard Australian (available locally at Dermatology and Laser of Alabama), Badger Kids Sunscreen (available locally at Village Dermatology). Parents should be advised to avoid sun exposure in their infants, especially during the hottest hours of the day (between 10am-4pm), seek shade when they are outside, dress in loose protective clothing and hats, and hydrate appropriately.
Step two begins when those same children enter tween/teen years. Our focus should expand to include daily regimens aimed at prevention and treatment of skin disease, namely acne.
Acne treatment is a business, and business is booming. While pharmaceutical reps for prescription acne medications are abundant, I have only met one who detailed products targeted at providing solid foundations for skin health. As physicians, we are left with the same resources parents are left with: media. Forbes estimated in 2010 Guthy-Renker (the makers of ProActiv) took in $800million in revenue from ProActiv alone. With celebrities such as Justin Bieber and Katy Perry claiming ProActiv improved their acne, teens and their parents credit cards are often sold on promises of clear complexions and bleached white smiles. As I tell my children, “just because you saw it on television, doesn’t make it real.” Often those same patients come in frustrated and several dollars lighter complaining about irritation and less than satisfactory results.
The effects of acne reach beyond just the monthly credit card statements. Affecting over 50 million Americans, the scars left behind by acne are often deeper than just physical findings. Teens with acne report higher incidence of depression, suicidal ideation, anxiety, psychosomatic symptoms, including pain and discomfort, embarrassment and social inhibition. Effective acne treatment improves self-esteem, affect, body image, social assertiveness and self-confidence.
While the number of OTC and prescription acne medication regimens are vast what we often overlook is basic skin care essentials. Think of it as mise en place. Adequately cleansing, moisturizing and protecting the skin are important weapons in our arsenal against acne in addition to the various prescription choices. Many patients will require topical antimicrobials and/or combination products, some will need more in depth treatments such as Accutane or procedural therapies which are usually administered in a Dermatologist office. But we can start the conversation during our routine visits and we can familiarize ourselves with the various options for good skin care foundations in our patients.
Dr. Kelli H. Tapley is with Birmingham Pediatric Associates