“Do children need photoprotection? Definitely yes,” stated Henry W. Lim, MD, former director of the Department of Dermatology at Henry Ford Health in Detroit, former president of the American Academy of Dermatology, and current president of the International League of Dermatological Societies, during a presentation at The World Congress of Pediatric Dermatology (WCPD) 2025 Annual Meeting held this month in Buenos Aires, Argentina.
Lim reminded the audience that within the solar spectrum, visible light, infrared radiation, and ultraviolet (UV) radiation reach the Earth’s surface, representing 47%, 51%, and 2% of the total at sea level, respectively. UV radiation is the most photobiologically active. UVB and short-wavelength UVA rays cause erythema and photocarcinogenesis, primarily affecting individuals with low phototypes (I-III). Long-wavelength UVA1 rays cause tanning, photoaging, and photocarcinogenesis, with more prominent effects in individuals with intermediate to high phototypes (IV-VI).
Visible light, often less understood, causes erythema in all skin types and tanning, especially in phototypes IV-VI, Lim noted. While both UVA1 radiation and visible light induce rapid pigmentation in phototypes IV-VI, the effects of visible light last longer, and both types of radiation have a synergistic effect. Photoprotectors with color, which are widely available in the market, provide protection against both UV radiation and visible light.
Photoprotection in Dark-Skinned Populations
Photoprotection in pediatric populations with darker skin is often misunderstood. While melanin in darker skin can filter two to five times more UV radiation than that in lighter skin, and the epidermis of phototypes V-VI has an intrinsic sun protection factor of 13.4 (four times higher than in lower phototypes), protection is still not complete. Exposure can lead to conditions ranging from hyperpigmentation to skin cancer later in life. “In dark skin, the risk is lower, but it’s not zero,” emphasized Lim.
Lim explained that regardless of skin color, the pediatric population is at a high risk for sun exposure: They have a thinner stratum corneum, less melanin, and tend to spend more time outdoors than adults. Additionally, there is a correlation between childhood sunburn history and skin cancer, with sun-induced nevi or moles potentially contributing to melanoma risk.
“The Hispanic and Black pediatric populations are less likely to engage in protective behaviors, primarily because these groups have been less concerned about the effects of sunlight,” Lim noted. However, a recent study of Hispanic/Latino pediatric populations in California showed that knowledge of photoprotection measures and family discussions about sunscreen use were inversely related to the amount of time children spent outdoors. “I believe that educating families about photoprotection is very important,” Lim emphasized.
Sunscreens: Benefits Outweigh Drawbacks
During his presentation, Lim also addressed the use of sunscreens, stating that “while they are not the only factor in photoprotection, they are very important.” He highlighted that the US Food and Drug Administration considers only inorganic UV filters (eg, titanium dioxide and zinc oxide) to be “safe and effective” for children aged 6 months to 2 years. In a recent international expert panel on personalized photoprotection, 75% of members agreed that for pediatric populations in this age group, “mineral” UV filters should “preferably” be used.
“For children under 2 years, I recommend shade, hats, and clothing and applying only mineral sunscreens to exposed areas, which should be removed once indoors,” Lim advised.
Endocrine Disruptors and Environmental Impact
Lim raised concerns about the presence of endocrine disruptors, such as phthalates, in sunscreens and the environmental impact of chemical filters like oxybenzone on coral bleaching. “The data are not always solid, but there is significant controversy, and parents are aware of these issues because they read about them online,” he acknowledged.
Another panelist at the session, Fernando Stengel, MD, dermatologist and co-founder of the Argentina Skin Cancer Foundation, emphasized the potential environmental harm caused by chemical sunscreens. He pointed out that global warming is a more significant factor in coral bleaching than the filters themselves.
“Our responsibility as dermatologists is to understand and emphasize the facts, no matter how incomplete they may be, and communicate them in the right context,” said Stengel. “The benefits of proper sunscreen use far outweigh the potential drawbacks. If concerns about human toxicity or environmental impact persist, we should prescribe mineral filters or replace questionable ultraviolet filters (eg, oxybenzone, octocrylene, octinoxate) with newly approved organic filters.”
Lim and Stengel both agreed that limiting sun exposure and using physical barriers such as shade, clothing, hats, and sunglasses should be prioritized to reduce reliance on sunscreens.
Endocrine Disruptors and Environmental Impact
María Soledad Aluma, dermatologist and Mohs micrographic surgery specialist, director of the Skin Cancer Foundation Colombia, contributed to motivating children through art. In 2015, she created the story Aurelio, el sol naciente (“Aurelio, the Rising Sun”), which “tells of a new sun that not only illuminates but also gives life to humanity, requiring humans to protect themselves through hats, umbrellas, glasses, and sunscreen,” Aluma told Medscape’s Spanish edition.
This story has won awards at dermatology congresses and health science research competitions and has been used as a tool to intervene with more than 5000 schoolchildren in Medellín and its metropolitan area, accompanied by artists who narrate the story, interact with the children, and reinforce the message with activities and dermatology experts.
A clinical trial published in 2020 showed that such interventions improve solar protection behaviors. However, Aluma mentioned financial challenges and socioeconomic barriers to implementing such campaigns, especially in public schools with fewer resources. “In these populations, advocating for daily sunscreen use is not feasible, and it often causes anxiety and concern,” she noted.
Aluma emphasized the importance of reinforcing skin care, particularly regarding the risks of intense, intermittent sun exposure and sunburn in children. “There is still a gap between knowledge and actual photoprotection practices in the population,” she said. She also suggested educating children about sun exposure times with higher radiation levels, particularly for athletes involved in outdoor activities, as they are at a higher risk for skin cancer later in life.
Andrea Santos Muñoz, pediatric dermatologist from Argentina, also participated in the congress and highlighted that children younger than 9 years are more likely to adopt habits effectively, primarily through family imitation. “Just like teaching them to bathe and brush their teeth, we must teach them the importance of photoprotection, which includes daily sunscreen use, even on cloudy days, and other protective measures like seeking shade and wearing hats,” she concluded.
Lim declared receiving consulting fees from ISDIN, Beiersdorf, Ferndale, L'Oréal, Eli Lilly, Zerigo Health, Skinosive, and Kenvue and being a speaker at educational sessions for La Roche-Posay, Cantabria Labs, Pierre Fabre, ISDIN, NAOS, Uriage, and Pfizer. Santos Muñoz works as a medical influencer for La Roche-Posay. Stengel and Aluma declared no relevant financial conflicts of interest.
This story was translated from Medscape’s Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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