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SPF

Joshua Bozek. Photo courtesy Bozek

By Aidan Johnson

Summer has arrived, and with it warm weather and longer days. However, as kids participate in outdoor activities, it is important for parents, coaches and camp counselors to watch for signs of heat-related illnesses, including heatstroke, sunburns and dehydration.

Dr. Joshua Bozek, emergency medicine physician at St. Catherine of Siena Hospital in Smithtown, discussed how to identify the causes of heat-related illnesses in kids in an exclusive interview June 5.

“The first thing that I usually look for is when the kids are grabbing for their water bottle a little bit more frequently,” Bozek said.

“If they suddenly start feeling kind of weak, more tired … let’s say they’re playing a sport and suddenly they want to go on the bench, that’s a sign that they’re getting a heat illness,” he said, also noting nausea and vomiting, muscle cramps and irritability. He described more serious symptoms such as fainting, severe headaches and cool, clammy skin.

It’s important to remember that some conditions, such as heatstroke, do not only occur outside or on sunny days, but can happen when it’s cloudy or in places like gyms.

If symptoms of heat illness appear to be present in a child, it is important to move to a cooler area, such as a building with air conditioning. He suggested changing to lighter clothing like shorts and a T-shirt and laying the child down with their feet slightly raised.

If the symptoms start to progress even more, Bozek recommended spreading water on their skin, which can help to cool down the blood vessels underneath, though he clarified that this shouldn’t be done to the point where the child is frigid.

Importance of hydration

“As long as they’re not actively vomiting, you want to try to get some fluids into their system,” Bozek said, adding, “If you drink some cold liquid, your esophagus, your stomach, your intestines, until it warms up will help cool you from the inside out.”

However, if symptoms continue to worsen to severe vomiting, fainting or seizure activity, the best option would be dialing 911.

Bozek also discussed preventing sunburn in children, saying, “The number one thing that you can do with kids that are going to be out, particularly when they’re at camp, is making sure that they have adequate amounts of sunblock on and reapplying frequently.”

Hydration once again plays an important role, as when sunburn progresses and the skin gets hot, which dehydrates the inflicted person much more quickly. Therefore, it is important to drink more water than normal, even if the kids are not feeling thirsty.

Sunburns can progress into severe degrees of burns, with blistering being a sign of severity.

“You don’t want to get to the point where you’re actually getting some necrosis of the skin or blisters that become deep, but the main thing is just when it’s very sunny out, if you can do activities that are in the shade or indoors, that’s better,” the emergency doctor added.

Bozek noted the difference between sunscreen and sunblock, with sunscreen used as the generalized “full body preventative measure,” and sunblock being used more “for areas that are at higher risk,” such as the ears and nose, since they’re directly pointing up to the sky.

It’s important to remember to apply sunblock to the lips, as it is possible to develop blisters, or even skin cancer, if left unprotected. Additionally, wearing a hat can keep the sun off of a person’s scalp and potentially cool them down by providing some shade to their face.

Bozek recommends using SPF 50 and above for children.

Kids are more susceptible to sun burning and dehydration due to having more sensitive skin and being able to drink less liquid than an adult, along with not necessarily being able to recognize the symptoms of heat-related conditions as well. 

It is important for everyone to practice safety in the heat and sun, so the fun can continue throughout the summer.

Photo by Julianne Mosher

Town of Brookhaven pools and beaches will now have stations so people can get their SPF.

During a press conference at Cedar Beach West in Mount Sinai Thursday, July 29, Supervisor Ed Romaine (R) and Councilwoman Jane Bonner (R-Rocky Point) announced that new, free sunscreen stations will start to pop up thanks to a collaboration with Northwell Health.

The touchless applicator stations will release the sunscreen so people can use it before they head to the beach — a reminder as soon as they walk in that it’s there. 

Photo by Julianne Mosher

“We can’t stress the importance of sunscreen enough,” Bonner said. “You have to start when you’re very young, you have to prevent the burns and prevent the exposure that builds up over time — even if it’s an overcast day.”

Nancy Uzo, vice president for public affairs at Mather Hospital, said that skin cancer affects one in five adults by the time they hit age 70. 

“If you have had five bad sunburns in your lifetime, your risk of developing melanoma goes up substantially,” she said. 

The free sunscreen program was initiated to generate awareness about how sunscreen can make a difference in the spread of skin cancer and melanoma.  

The program was launched by Creative Advertising Concepts which set up the first sunscreen program, in the City of Long Beach with partner Winthrop Hospital, back in 2017. Currently, CAC manages 13 programs with 11 on Long Island and two in Westchester County. 

The sunscreen dispensers are endorsed by IMPACT Melanoma — a national nonprofit dedicated to working to reduce the incidence of melanoma.

Romaine said that when he was young, he never used sunscreen — and it led to skin cancer later on. 

“I’ve had surgery on my arm, surgery on my head, the tip of my nose from skin cancer,” he said. “It is something that happens if you get too much sun exposure. … You’ve got to protect yourself. We have to say ‘no’ to skin cancer.”

People should go through several bottles of sunscreen in one season. Using an ounce of sunscreen is ideal, as companies measure the SPF of a sunscreen by applying that amount of sunscreen to the body. Photo by Giselle Barkley

A little dab here and a little dab there. That’s usually how people apply sunscreen to their skin, according to Dr. Michael Dannenberg of Dermatology Associates of Huntington, chief of dermatology at Huntington Hospital. But with around one in five people developing skin cancer on their scalp, a dab of sunscreen isn’t enough.

Skin cancer is one of the most prevalent cancers in America, and cases for scalp cancer have increased in the past several years. While those who don’t have hair may be more prone to getting scalp cancer in comparison to those with hair, anyone can develop any form of skin cancer on this area of their body.

Squamous cell and basal cell carcinoma are common for those who are frequently exposed to the sun and those who are losing hair. Melanoma can also develop on the scalp. In 1935, one in 1,500 people developed melanoma, but the rate has since increased. Now, one in 50 people have a lifetime risk of developing melanoma.

According to Dr. Tara Huston, a surgeon in the Melanoma Management Team for Stony Brook Medicine, there will be 74,000 new cases this year of melanoma in the United States alone. Huston also said that this form of skin cancer usually requires a surgeon’s attention, as it calls for “a larger excision margin than either basal or squamous cell skin cancer.”

Huston and her team help patients with various forms of skin cancer. While dermatologists treat skin cancers like melanoma if caught early, people with more advanced stages of skin cancer may need surgery and additional treatment to recover. A patient’s lymph nodes are also examined. Lymph nodes are responsible for the drainage of certain parts of the skin. Doctors can further repair issues found from examining the nodes associated with the cancer in that area.

Sunburns, above, and increased sun exposure increase an individual’s risk of getting skin cancer like Melanoma, which accounts for four percent of cases, but 75 percent of skin cancer-related deaths according to Dr. Huston. Photo from Alexandra Zendrian
Sunburns, above, and increased sun exposure increase an individual’s risk of getting skin cancer like Melanoma, which accounts for four percent of cases, but 75 percent of skin cancer-related deaths according to Dr. Huston. Photo from Alexandra Zendrian

Although skin cancer of the scalp is not difficult to detect, Dr. Dannenberg says it can be missed because it is on the head. Lesions can vary based on the form of skin cancer on the scalp. Yet, it is easy to detect, especially when people receive frequent haircuts. According to Dannenberg, his office receives countless referrals from barbers and hairstylists who may find a cancerous lesion on their client’s heads.

Huston agreed with Dannenberg regarding the role of barbers and hairstylists, as a number of skin cancer lesions are identified by these professionals.

Squamous cell carcinoma appears in dull, red, rough and scaly lesions, while basal cell carcinoma appears as raised, pink and wax-like bumps that can bleed. Melanoma on the scalp appears as it would on any other part of the body — irregularly shaped, dark-colored lesions.

While sunscreen is more often associated with skin protection, dermatologists like Dannenberg also recommend protective clothing and hats. Cloth hats allow the wearer’s head to breathe while protecting the scalp. Hats with a three and a half inch or more rim offer the best protection, as they cover the head while protecting the ears and other parts of the face or neck. While people can also use straw hats, the hats should be densely woven and not allow sun to penetrate. Hats as well as sunscreen and protective clothing should be used together to provide people with the best form of sun protection.

“Nobody is completely compulsive about putting on that hat every moment they walk out the door,” Dannenberg said. “Likewise, even for people [who] are using sunscreens, people tend not to use enough of it and they don’t reapply it as often as necessary.”

One ounce of sunscreen might be hard to hold without dripping down the side of someone’s hand, but it is the amount of sunscreen people should use on their entire body. Dannenberg also says that sunscreens usually last for about three hours before people need to reapply.

Since few people follow the directions when applying sunscreen, Dannenberg as well as the American Academy of Dermatology recommend people use sunscreens with at least SPF 30. Using sunscreens with higher SPF counts means that people can under apply and still get some degree of sun and ultraviolet radiation protection.

Huston said individuals who don’t want to wear sunscreen or those with a history of tanning should seek a dermatologist and schedule appointments at least once a year to conduct a full body skin examination.

According to Huston, operating on areas of the head like the ears, nose, eyelids, lips and scalp is difficult because of the surrounding tissue.

“Reconstruction of a 2 cm defect on the nose may require multiple stages/surgeries in order to optimize the aesthetic result,” Huston said in an e-mail interview.

While some patients need skin grafts upon the removal of a cancerous lesion, Huston said, “incisions on the scalp can lead to alopecia, or hair loss along the incision line, if it stretches, and can be very upsetting to patients.”

Both Huston and Dannenberg emphasized the importance of protecting the skin and skin cancer education. Dannenberg hopes that the rates of skin cancer will decrease if people are more consistent about protecting their skin with protective attire, sunscreen and hats.

“We’ve been talking to people for years about wearing hats…telling them that as fashion always seems to follow need, that these hats are going to be coming in style,” Dannenberg said. “We’re hoping that over the next 10 or 15 years, we’ll be able to get a drop in the incidences of skin cancer.”