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How Nurse Practitioners Can Promote Safe Skin Care This Summer

Promoting Proper Summer Skin Care

Nurse practitioners can help patients understand the benefits of avoiding exposure to too much sunlight.

At the beginning of 2024, NASA confirmed what anyone who spent any time outside during the summer of 2023 could have guessed — that year boasted the hottest summer on record. “Overall, Earth was about 2.5 degrees Fahrenheit (or about 1.4 degrees Celsius) warmer in 2023 than the late 19th-century average, when modern record-keeping began,” they reported. Summer of 2024 could shock us by being unusually cool, but chances are — if the end of May is any indication — that it will be unsurprisingly hot.

Balancing summer fun with concern over the harmful effects of ultraviolet (UV) rays is something top of mind for many nurse practitioners (NPs) and especially parents of small children. Spending time outdoors is a big part of summer vacation for kids, and it’s good for the body to enjoy some time taking in the sun’s rays. As Rosario Rose Sakamoto, DrPH, MSN, ANP-BC, wrote in an article for the Journal for Nurse Practitioners (JNP) entitled Sunlight in Vitamin D Deficiency: Clinical Implications, “sensible sun exposure mitigates the effects of hypovitaminosis D and other age-related diseases.”

But NPs know that too much sun exposure puts patients at risk for a number of other diseases, including skin cancer. As per the United States Environmental Protection Agency (EPA), “Each year, more new cases of skin cancer are diagnosed in the U.S. than new cases of breast, prostate, lung and colon cancer combined. One in five Americans will develop skin cancer in their lifetime. One American dies from skin cancer every hour. Unprotected exposure to UV radiation is the most preventable risk factor for skin cancer.”

To help remain sensible when it comes to sun exposure, read on for some useful advice from co-chair of the American Association of Nurse Practitioners® (AANP) Dermatology Community Leigh Ann Pansch, MSN, FNP-BC, DCNP, and visit resources concerned with keeping everyone safe and happy in the sun this summer season.

No Myths Under the Sun

One misconception Pansch wants to correct is the idea that tanning one’s skin prevents skin cancer. “This is one of those conversations we should be having with every patient, especially this time of year,” she says. “There are still a lot of people who feel like a tan is somehow protective. And probably in certain skin types it might be protective against a burn, but it does not protect against skin cancer. I think people assume that we get skin cancer because of burns. The reality is that every burn before the age of 18 is a risk factor, but I think of it as an empty sun exposure bank that we’re born with. There comes a point where after we’re in the sun a lot, that bank gets full.”

As for actual protection, patients should know some of the basic facts about sunscreen, including that, according to the CDC, “sunscreen without an expiration date has a shelf life of no more than 3 years.” Sunscreen should also be “broad spectrum,” meaning that they have passed the “FDA’s broad-spectrum requirements, and therefore protect against UVA exposure.” The FDA points out that no sunscreen is waterproof, but should be water resistant, and “water resistance claims, for 40 or 80 minutes, tell you how much time you can expect to get the labeled SPF-level of protection while swimming or sweating.”

Pansch centers sunscreen use as a necessary, commonsense safety precaution. “What I typically say is that when I was a kid, nobody wore seatbelts. Now we don’t get into a car without a seatbelt, and we should think of sunscreen at 30 SPF as our seatbelt,” she says. Pansch states that we should be “reapplying every two hours to every skin service that’s exposed, unless we’re swimming or sweating profusely — then it should be hourly.”

She also recommends getting children involved in their own sunscreen application. “Children as young as three can learn, ‘I’ll do an arm, you do an arm.’” Pansch also recommends thinking ahead about future applications: “Thinking about your day and your time in the sun is very helpful, especially with children. If we’re going to the amusement park today, we’re going to put the sunscreen on before we go, and I’m going to put some samples in your lunch box so that you can reapply, and then I’ll set a timer at 2 p.m. so you can reapply before I pick you up at 4 p.m.”

Sun Protection in 2024

After they’ve applied their sunscreen, remind patients to “wear clothing that covers,” including hats. Sunglasses are also recommended, but like sunscreen, users need to ensure they’re using the product correctly. The FDA notes to “not mistake dark-tinted sunglasses as having UV protection,” and to instead “choose sunglasses with a UV400 rating or ‘100% UV protection’ on the label.” They also indicate that “many sunglasses with light-colored tints – such as green, amber, red, and gray – can offer the same UV protection as very dark lenses.”

It's a good idea to avoid the times when UV rays are the strongest – the EPA says that’s between 10 a.m. and 4 p.m., while the FDA says “the sun’s rays are most intense” between 10 a.m. and 2 p.m. In any case, avoiding these times will limit UV exposure, and even during those hours, remaining out of the sun’s direct rays and in shade will also make a difference. In her own experience, Pansch says, “maybe we’ll go in the morning one day and then leave, and make sure we have shade while we’re there. We don’t have to be in peak sun every single day of our seven-day vacation.”

Taking Sun Seriously

If you’re interested in a more hands-on approach to sun safety, consider a number of programs offered by the National Cancer Institute, which range from the general (“Block the Sun, Not the Fun”) to the very specific (“Promoting Sun Safety Among Zoo Visitors”). Finally, AANP has created a community specifically tailored to dermatology, where interested NPs who are focused on this specialty — or simply interested in it — may join and gain access to an online forum, document sharing and exchange knowledge with other dermatology-focused AANP members.