Ultraviolet Radiation: A Hazard to Children and Adolescents

Abstract

Ultraviolet radiation (UVR) causes the 3 major forms of skin cancer: basal cell carcinoma; squamous cell carcinoma; and cutaneous malignant melanoma. Public awareness of the risk is not optimal, overall compliance with sun protection is inconsistent, and melanoma rates continue to rise. The risk of skin cancer increases when people overexpose themselves to sun and intentionally expose themselves to artificial sources of UVR. Yet, people continue to sunburn, and teenagers and adults alike remain frequent visitors to tanning parlors. Pediatricians should provide advice about UVR exposure during healthsupervision visits and at other relevant times. Advice includes avoiding sunburning, wearing clothing and hats, timing activities (when possible) before or after periods of peak sun exposure, wearing protective sunglasses, and applying and reapplying sunscreen. Advice should be framed in the context of promoting outdoor physical activity. Adolescents should be strongly discouraged from visiting tanning parlors. Sun exposure and vitamin D status are intertwined. Cutaneous vitamin D production requires sunlight exposure, and many factors, such as skin pigmentation, season, and time of day, complicate efficiency of cutaneous vitamin D production that results from sun exposure. Adequate vitamin D is needed for bone health. Accumulating information suggests a beneficial influence of vitamin D on many health conditions. Although vitamin D is available through the diet, supplements, and incidental sun exposure, many children have low vitamin D concentrations. Ensuring vitamin D adequacy while promoting sun-protection strategies will require renewed attention to children's use of dietary and supplemental vitamin D. Pediatrics 2011;127:588-597 BACKGROUND Sunlight sustains life on earth. The sun provides warmth, is needed for photosynthesis, drives biorhythms, and promotes feelings of wellbeing, and sunlight is essential for vitamin D synthesis in skin.The sun emits ultraviolet ("above violet") radiation (UVR) waves that range from 200 to 400 nm. UVB (290 -320 nm) and UVA (320 -400 nm) rays penetrate the atmosphere and have the greatest biological significance. Solar radiation that reaches the earth's surface comprises approximately 95% UVA and 5% UVB rays. 1 Sand, snow, concrete, and water can reflect up to 85% of sunlight, thus intensifying exposure. 2 UVR can penetrate to a depth of 60 cm in water and result in significant exposure. UVA rays are relatively constant throughout the day and the year. UVB rays have greater intensity in summer than in winter, at midday than in morning or late afternoon, in

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