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Kids and Sunscreen Harms: Rare But Concerning for Parents

Coen sunscreen rash

June 1, 2018 -- When Rian Sands headed out on a boat ride in April with her husband and four children, she brought along the family’s regular sunscreen for their bodies and a new sunscreen face stick to try.

“They hate sunscreen on their faces, so I got a stick, thinking this will be easier,” the 36-year-old mother from Destin, FL, says.

Several hours after the trip, she noticed changes in all four children’s appearance -- their eyes were red and puffy underneath.

“The sunscreen was the common denominator. Their face was the only place I used it.”

Sands says the three oldest children were miserable for about a day, and it took 3 days for her youngest daughter to recover.

“They were all super uncomfortable. They couldn’t sleep,” she says.

She shared photos and the story on social media because she says she had no idea this could happen.

“I thought I was doing a good thing -- protecting my babies’ faces,” Sands says. “It never crossed my mind that something bad could happen.”

Allergies to Sunscreen

Doctors stress the overall benefits of sunscreen far outweigh the risks of reactions. Sunscreen helps lower the chance of skin cancer, sunburn, and premature skin aging caused by the sun.

But people can have a variety of skin reactions to sunscreen, known as contact dermatitis. A milder type, known as irritant contact dermatitis, involves redness or a stinging feeling where sunscreen was applied.

An allergic reaction known as allergic contact dermatitis is rarer, affecting less than 1% of the population. It may involve a rash, itchy skin, swelling, or blistering, and it takes a day or more to develop.

Adam Friedman, MD, an associate professor of dermatology at George Washington School of Medicine in Washington, D.C., says while sunscreen irritations generally happen around the time you put it on, allergic reactions can take a day or more to see.

It’s also possible to have a reaction when a sunscreen ingredient interacts with sunlight, often leaving people looking like they have a severe sunburn. This happens in a very small number of users and is unique to certain people, Freidman says.

While allergic reactions are also rare, it’s not uncommon to see reports of them on social media. Jamie (who asked that we not use her last name to protect her family’s privacy) of Manhattan, KS, shared photos on Instagram and her blog in late April 2018 after she says her son had his second reaction to sunscreen. “It is traumatic for a mom. They are so little, and you think you are doing the best thing for your child, so I want others to at least know this can happen,” she says.

The two times it happened to her son Coen, his face and eyes swelled several hours to a full day after the sunscreen was applied.

“It was worse the first time because I put it all over him. His eyes were almost swollen shut. We were going to take him to the ER. I was panicking. I called my mother-in-law, who said give him Benadryl to see if it helps, and it did,” Jamie says.

A year later, it happened again. Coen’s reaction was visible after he woke up from a nap. “He looked so horrible,” Jamie says. “It all clicked for me. Sunscreen was the only thing I had done differently, and you could actually see his reaction where I had smeared it around his face and down his neck.”

Investigating Reports of Allergic Reactions

Sandy Walsh, a spokeswoman for the FDA, says the agency is aware that rare cases of children's serious allergic reactions to sunscreens have been reported.

“Infants are at greater risk than adults of sunscreen side effects, such as a rash,” she says. Babies have skin that is less mature than adult skin, and they have a higher ratio of skin to body weight compared with older children and adults, she says.

“Both these factors mean that an infant’s exposure to the chemicals in sunscreens may be much greater, increasing the risk of side effects from the sunscreen,” Walsh says.

She says the FDA continually looks for reports of side effects as well as safety information from other sources to find out if the agency needs to take action or share new information about sunscreens.

Health Canada, that country’s national public health department, is doing its own evaluation, too. It began testing one brand -- Banana Boat sunscreen -- in May 2017 after media reports of burns associated with the products. Department spokeswoman Renelle Briand says the tests did not identify any serious quality concerns with the Banana Boat products it evaluated.

She says in the last year, her agency has gotten 323 reports of problems involving Banana Boat sunscreens. It received reports in 2017 about other sunscreen brands as well through its Canada Vigilance website.

Briand says as a result, Health Canada started a broader review of Banana Boat and other sunscreen brands. The safety review focuses on suspected cases of skin reactions, including those reported by consumers as “burns” and rashes. It includes a review of data from sunscreen makers, published studies, and international agencies to see whether the sunscreen may have caused the reactions.

The department’s focus is on products labeled for children. Health Canada expects to have a report this summer.

In a statement, Edgewell Personal Care, the makers of Banana Boat sunscreen, says its number one priority is safety.

“Banana Boat sunscreens ... are safe for human skin, topical use and cannot cause chemical burns, which are sometimes mistakenly linked to personal care products or confused with sunburns,” the agency wrote, referring to the initial Health Canada report that didn’t find quality concerns with its products.

How to Be Smart With Sunscreen

Allergic reactions to sunscreen can come from a variety of its ingredients. This includes inactive ones, like fragrances or preservatives, and active ones, which can either be chemical-based -- like avobenzone, octinoxate, and octocrylene -- or mineral-based -- like zinc oxide and titanium dioxide.

Mineral-based sunscreens are less likely to cause allergic reactions because the heavier cream sits on top of the skin, scattering the UV rays, and does not penetrate the skin. But these sunscreens are generally a very white, thick cream, which can be unappealing, although newer “micronized” formulas make them easier to use.

Still, experts say, when it comes to sunscreen, you have to be practical, too.

“The bottom line is that the best sunscreen is a sunscreen you will actually use and reapply. So if you hate it and won’t reapply it, then it isn’t the best product for you or your family,” says Kalyani Marathe MD, a pediatric dermatologist at Children’s National Health System in Washington, D.C. “If it’s super-duper white or has a weird smell that you or your kids will hate, then find something you will actually use.”

Marathe says a great way to do that is to test a new sunscreen on a 2-by-2-inch patch on the inside of your or your child’s arm between the elbow and wrist twice a day for a week and see if there's a reaction.

Dermatologists stress that while parents are right to be thoughtful about the products they use, sunscreen allergies shouldn’t scare them away from the products.

“Yes this can happen. It’s not dangerous, just annoying. But skin cancer kills. It’s one of the most common cancers, and that is something to really be afraid of,” George Washington’s Friedman says. “I think it’s more important to protect ourselves in the sun than to allow fear to prevent us from using a validated and well-understood tool to prevent skin cancer in ourselves and especially our children.”

Other tips for parents:

  • The FDA says infants younger than 6 months should be kept out of the sun between 10 a.m. and 2 p.m., and it says parents should use protective clothing if they have to be in the sun.
  • For children and infants older than 6 months, the FDA recommends using sunscreen as directed on the Drug Facts label of various products.
  • Use broad-spectrum sunscreens with SPF values of 30 or higher.
  • Marathe says if you are using mineral-based sunscreen, look for one with 10%-15% zinc oxide and 5% or more titanium dioxide.
  • Avoid spray sunscreen because it can be hard to find out how well it's covering you. If you do use one, spray it into your hand before putting it on your face, rather than spraying it directly onto your face and inhaling chemicals.
  • Put on sunscreen 20 minutes before you go outside. Reapply it every 2 hours when you're in the sun and every hour if you're sweating or swimming.
  • Don’t just rely on sunscreen to protect against the sun. Use clothing with SPF protection, hats, and rash guard shirts at the pool.
  • If you or your child has a reaction to the sunscreen, rinse the skin quickly to remove the sunscreen, and then slather the affected area with petroleum jelly. Stop using the sunscreen and seek medical advice.
  • Report problems to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program: www.fda.gov/MedWatch/report
WebMD Article Reviewed by Neha Pathak, MD on June 01, 2018

Sources

Jamie, Manhattan, KS.

Rian Sands, Destin, FL.

Renelle Briand, spokeswoman, Health Canada, Ottawa, Ontario.

Edgewell Personal Care representative, New York City.

Adam Friedman, MD, associate professor of dermatology, George Washington University, Washington, D.C.

Kalyani Marathe MD, pediatric dermatologist, Children’s National Health System, Washington, D.C.

Sandy Walsh, spokeswoman, FDA, Silver Spring, MD.

Dermatitis: "Sunscreen allergy: A review of epidemiology, clinical characteristics, and responsible allergens."

The Environmental Working Group: “The Trouble with Ingredients in Sunscreens.”

Cancer Council Australia: “Sunscreen reactions.”

FDA: “The Sun and Your Medicine,” “How to protect your skin from the sun.”

Canada Vigilance.

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