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Dr. Tarbox: Hello and welcome to "Skincast," the podcast that teaches you how to take the very best care of the skin you're in. I'm Michelle Tarbox. I'm an Associate Professor of Dermatology and Dermatopathology at Texas Tech University ÐÇ¿Õ´«Ã½ Sciences Center in beautiful, sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hey, this is Luke Johnson. I am a pediatric dermatologist and a general dermatologist with the University of Utah.

Dr. Tarbox: So today we're going to talk about skincare and kids. We really want to begin our journey towards experiencing a full and happy life living in the skin we're in, in childhood, because that's how we can protect it the best from any kind of early damage. So why is sun protection important, Luke?

Dr. Johnson: Yeah, I think we're going to spend a lot of this episode talking about sun protection, because kids are generally a lot healthier than adults and their skin is also a lot healthier than adult skin for the most part. But one thing you can do to help keep it healthy is by protecting them from the sun.

It's important for a lot of reasons. One, of course, is skin cancer prevention. So there are a lot of different kinds of skin cancer. Melanoma is the one most people know about, and with good reason because it's one that can kill people, though most melanomas don't. So protecting your kids from the sun can help reduce or prevent the development of skin cancer later in life.

Dr. Tarbox: Of course, I know parents often have questions about which sunscreens are the safest and which ones have the least probability of irritating the skin. So we do want to think about the ingredients that are in the different sunscreens and how we use those for children. I think if you focus on mineral-based products that are designed for use on children's skin you can do pretty well with this.

Now, some people got a little bit concerned about a recent study showing benzene in some sunscreens. The vast majority of the sunscreens that were contaminated with benzenes were either gels or sprays. There were a few lotions on that list, but there are many lists available that have the benzene-free sunscreens that are quite safe listed.

Some of the favorite ones that people have on this show include some of the Badger Kids Broad Spectrum Sunscreen with natural minerals in it. Some people really like the Blue Lizard products. There's Babyganics, which is organic and baby put together. That's a mineral-based sunscreen spray that's actually benzene-free. Do you have any favorites, Luke?

Dr. Johnson: So I'm a pediatric dermatologist and a general dermatologist. So being a general dermatologist means I take care of high-ranking military officials, and being a pediatric dermatologist means I take care of kids. So a lot of times I have parents ask me if I have recommendations for sunscreen for kids. And what I usually tell them is to use the mineral-based sunscreens. You've heard us say that a couple of times.

So there are two different ways that sunscreens can prevent the sun radiation from damaging your skin. There's the chemical way and then there's the mineral way. And there are medical studies that show that the chemical-based sunscreens get absorbed into your blood. We don't know that they do anything bad if they get absorbed into your blood, but to play it safe for kids, I feel like we should use the mineral-based sunscreens. Specifically, those ingredients are titanium or zinc, because we know those stay on the surface of the skin where they belong.

Modern sunscreens come in a lot of different ways. So if you don't like sunscreen or your kid doesn't like sunscreen, well, maybe we just haven't found the right one.

In addition to the standard creams and lotions and so on, there are also sprays. There are mineral-based sprays, zinc and titanium. I know Trader Joe's has one. It is about twice as expensive as the chemical-based one, but it's out there. There are also powders that you can sort of brush on with a big brush, and there are sticks and roll-on things so kids could maybe even apply them to themselves.

Dr. Tarbox: When we're talking about sunscreen, which sunscreen you use is very important but also using enough sunscreen is important as well, as important as reapplying it frequently.

So when we talk about sunscreens and their strength, they're studied in labs at a density of application that's about twice what a normal human being would put on. Now, this is important because when we talk about sunscreen application, if you're applying half as much as was studied, you're not getting half the protection. You're actually getting the square root of the protection. So putting enough sunscreen on is important.

Dr. Johnson: And then reapplying it every 90 minutes to 2 hours if you're going to be out in the sun is another hurdle that dermatologists face. Once we get our patients to actually use sunscreen, it's to use enough and to keep putting it on.

We talked about skin cancer prevention. Protecting your kids from the sun can also help prevent something called photo-aging. So the longer and more sun radiation you've had over the course of your life, the older your skin looks. And of course, there's sunburn as well that we look out for.

Kids normally don't like sunscreen. I'm sorry. That's the way it is. So they just have to wear it anyway. It's still a battle with my kids to get them to wear it. But they want to go outside? Got to wear their sunscreen.

Dr. Tarbox: Now some things that might be a little bit easier to get a kid to work with you for would be potentially sun-protective clothing. There are lots of different kinds of sun-protective clothing brands that make good quality and attractive garments that can help protect the skin from the sun. What are your favorites, Luke?

Dr. Johnson: So what you're referring to is clothing that has what's called a UPF rather than SPF. So the UPF is sort of the clothing version of an SPF. There are a lot of brands that make specific sun protective clothing including Coolibar, which is my family's preferred one. We're not sponsored, by the way. There's also a brand called Solumbra. And then if you just Google or look on Amazon sun-protective shirt or sun-protective clothing, you'll find some fine products that are very reasonably priced.

And another reason I often recommend these is that, in addition to having to not worry about sunscreen on your arms if you're wearing a long sleeve shirt, these clothes are made to be worn when it's hot and sunny outside. So initially, if somebody tells you, "Wear a long sleeve shirt out in the sun," you're like, "What? That sounds miserable." But they're made of this lightweight, breathable fabric and they feel breezy and they're really quite pleasant to wear out in the sun.

Dr. Tarbox: I love my sun-protective clothing because it's sort of a no-brainer. You put it on and you know it's going to do its job. So you don't have to think about that reapplication and you don't have to worry that something is going to wear off.

Do you know what the name Coolibar comes from, Luke? It's actually kind of funny.

Dr. Johnson: I do not.

Dr. Tarbox: It actually comes from the eucalyptus coolabah tree, which is sometimes known kind of locally in Australia as coolibah. And so they made Coolibar, which is kind of fun.

The clothes are well made. You also have lots of options in terms of shopping sales. I always shop sales because I think thrifty is reasonable.

SunGuard is another option that you might have, which is actually a detergent that washes a sunscreen called Tinosorb into clothing and then that sunscreen lasts in the clothes for about 30 washes.

Dr. Johnson: Hats are important as well. Most of these sun protective clothing manufacturers also make nice hats. You want to wear one with a wide brim if you can. Not just a baseball cap, though, of course, that's way better than nothing. But a brim that goes all the way around. My kids have these hats from Coolibar that have the flap that also goes down the backs of their necks and shades that from the sun too.

Dr. Tarbox: When I'm talking to adults, I recommend a product called Heliocare that has an extract of a tropical fern that lives on the equator in it that helps to protect the skin against the sun from the inside. But a lot of kids can't swallow capsules, so there is a product called Sundaily, which are actually gummies that can be chewed and taken that have the polypodium leucotomos extract as well as vitamin D3 in there. And those tend to be pretty darn safe ingredients. So that's something you might not have to fight the kid on as hard.

Dr. Johnson: Babies probably shouldn't have any sun exposure before 6 months of age, and after that, you can go ahead and use sunscreens and so on if you have to, though be careful about marketing techniques. Sunscreens that say baby or kids on them aren't necessarily the mineral-based sunscreens that we would want. It's just a marketing tool. So be sure to look at the ingredients for zinc and/or titanium as the only active ingredients.

Dr. Tarbox: And sometimes those kid or baby sunscreens are very heavily fragranced with that sort of obnoxious baby powder fragrance. So you do want to make sure you're not using anything that's too heavily fragranced because it could irritate the skin.

Dr. Johnson: Using sunscreen and sun-protective clothing and so on, on your kids also helps them to create a habit early in life. So hopefully, when they go forward into adolescence and adults, they will carry the importance of sun protection with them.

Dr. Tarbox: I bet you get asked every day what to do about moisturizing kids' skin, Luke.

Dr. Johnson: Well, I do. I see a lot of kids with eczema and they tend to get dry skin. So the thicker and greasier the moisturizer is, the more effective it is. So I like petroleum jelly. Vaseline is one brand. Shea butter, coconut oil, and anything that you have to scoop out of a tub or squeeze out of a tube is going to be more effective than things that squirt out of bottles.

Now, if your skin doesn't get all that dry, you can probably just be fine with stuff that pumps out of bottles. But if you've got drier skin or eczema, you want to use the thicker stuff if you can.

Dr. Tarbox: And some of our kids get eczema. Some of them will be in the care of a dermatologist. But if they have just very mild eczema, using judiciously over-the-counter 1% hydrocortisone ointment can be beneficial, especially for occasional breakouts.

Dr. Johnson: You say judicious, but really you can't overdo it with hydrocortisone 1% ointment. It's wimpy enough that dermatologists sort of sneer at it. But it can be effective if you've got fairly mild eczema. Twice a day to areas of rash. As long as you're putting it on rash, you won't get into trouble. And once again, the ointment is more effective than the cream.

Dr. Tarbox: A lot of times the over-the-counter preparations also have a whole bunch of herbs and spices and aloe and all kinds of things in there. So simpler is usually better when you have a kid with irritated skin.

Dr. Johnson: If your child also has a tendency to get dry skin or eczema, then bathing techniques can be really helpful. If they don't have a history of eczema and don't have particularly dry skin, then do whatever you want with bathing. It doesn't really matter.

But for kids whose skin has a problem, baths are better than showers. They don't really need soap. So it turns out human skin doesn't really need soap to get clean except in the problem areas. But we don't really develop problem areas until we become smelly teenagers. So, for babies and kids, I normally recommend just plain water in a bath. Soak for about 10 minutes. After that time, take them out, and while they're still dripping wet, immediately slather them with your favorite moisturizer.

Dr. Tarbox: One thing you run into a lot with little girls is they love to take bubble baths or use those bath bombs or all sorts of fragrances and oils and sodium lauryl sulfate and things like that that can cause irritation of the skin all over the body, but also in the very sensitive areas for these little girls.

So if you have a little girl that's having that kind of trouble and she's a big fan of those bath bombs and the kind of bath glitter or whatever, trying to find something kind of more fun to replace that activity, maybe some different toys or maybe some little cutout foam things that you can kind of throw around the tub to sort of give that pretty appearance but without causing skin irritation would be a good idea.

Dr. Johnson: What dermatologists refer to as wet/dry cycles are especially drying on the skin. So water follows water. Water sort of attracts more water. So if you have water on your skin, for any reason, a bath, a shower, a romantic walk in the rain, a swimming pool and then that water goes away for whatever reason, you dry it with a towel or it air dries, it just takes more water from your skin away with it.

So if you are doing something that puts water on your skin and then it dries and that happens over and over again, those are wet/dry cycles that are really tough on the skin.

So we see that in kids in swimming pools, for example, because they're often in and out of the water because they're playing. They get out of the water and it dries and that sucks the water out of their skin, they get back in the water, and they just keep doing that. And then things like sponge baths will do it too, will really dry out your skin.

Dr. Tarbox: So breaking that up with moisturizing after a good cleansing bath is a good idea. Of course, if you have a kid that's swimming, especially in a public pool, rinsing the chlorine and also any other community schmutz off of them after that experience and then maybe putting a little gentle lotion on would be a good idea.

Dr. Johnson: A lot of pools are also out in the sun. I know we've already hammered sun protection, but I want to point out that even when it's not summer and you're at the pool, it's important to use sun protection. In the winter, it's still sunny in the winter and it reflects off of snow. It's important to use sun protection even on overcast days. I mean, you still can see outside. It's not like it's black. So there's still sun radiation coming down.

And then some people with darker skin types seem to be under the misapprehension that they don't need sunscreen, but that is not true. People with darker skin types still get still cancer and so forth.

Dr. Tarbox: Speaking of things that can come up more significantly with sun and things that show up in kids, one of the focuses of my practice is pigmented skin lesions, and those of course include moles. So a lot of parents will get really worried about moles on their children, and generally in children these spots are going to be absolutely harmless. There are a few circumstances when it's a good idea for a dermatologist to take a look and maybe follow some lesions. Those can include large birthmarks, anything that's growing very quickly or unusually, or a very strong family history of melanoma.

Dr. Johnson: So, for kids and moles, what I normally tell parents is the rules are basically the same as for adults. Anything changing is the most important thing to let us know about. But kids are growing and changing and so are their moles. Plus, the incidence of melanoma is extremely low in kids, especially before puberty. So we tolerate a little bit more change in the moles of kids than we do in adults. But it still doesn't give them a free ride. So anything new or changing, it's probably safest just to have us take a look at it even though we'll probably say, "Don't worry about it."

Dr. Tarbox: Of course, if anything is bleeding, if it's come up very quickly, or it looks very unusual, it's reasonable to get it looked at by a professional.

One other thing I like to tell the parents of small children is the better you do at protecting those kids against the damage of the sun, the fewer moles they'll have to deal with in adulthood. There are well-done studies that show us that sun exposure in childhood can increase the number of moles you have as an adult and can make it more difficult to follow those things over time as well as contributing to skin aging and potential for skin cancer. So lots of good reasons to be thoughtful about sun protection in kids.

Dr. Johnson: I sometimes have parents ask me, "When is it a good time for my kid to just get checked over head to toe and have a look at their moles?" There's not really an agreed upon guideline by any governing body in dermatology, but I think maybe it's a good idea for everybody to be checked out once in young adulthood, maybe in their 20s, and if there's nothing terrible going on, then they might not need a dermatologist ever again. But if there are some funny looking moles or anything, then we'll be able to say, "Okay, I guess we should see you ever year or every few years."

Dr. Tarbox: And then, of course, when we're talking about kids, kids are growing and changing all the time, and with those changes of childhood can come some of those changes of puberty. And of course, then kids start to have acne.

Dr. Johnson: Yes, we had a whole episode of acne. I believe it was Episode 4. So see that one if you want more information. But real quickly, at least for mild acne, there are some pretty good over-the-counter products.

One is called benzoyl peroxide. It comes in a lot of different forms. I like it best as a cleanser because I figure people are washing their face anyway. Might as well put some medicine in there so you don't have an extra step to do.

So if your son or daughter or you, I suppose, have some acne, try to get one of these benzoyl peroxide cleansers. Just wash your face with it every morning. It's best if it's in the morning. Just beware that it will stain your towels afterward. So use a white towel or a towel that you do not like.

There's also a product called Adapalene, which you can also buy over the counter. It's about $12. The brand name is Differin. It's a very good product to use at night. So put a little blob on your finger, dot, dot, dot around your face, and then rub it in.

And that's probably all we have time for in terms of kids and skin for today. So thanks for hanging out with us. You can find the rest of our archive on the University of Utah's website.

Thanks to the University of Utah, of course, for supporting the podcast and thanks to Texas Tech for lending us Michelle.

If you are a dermatology nerd like we are, you might be interested in another podcast that Michelle and I do called "Dermasphere." It's really intended for dermatologists, and we discuss some of the latest research in clinical dermatology. But hey, anybody can listen to it and we hope you would find that one fun too.