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For more information about skin conditions and treatment, contact:


Elizabeth H. Hamilton, MD, PhD
Amy Stein, MD
Julie Dodge, PA-C
4321 Medical Park Dr., #102
Durham, NC 27704
Telephone: (919) 220-7546 (SKIN)

A Common-Sense Approach
to Protecting Children’s Health

While acknowledging an increase in environmental toxins as a health concern, Dr. Elizabeth Hamilton, of Regional Dermatology in Durham, contends that “common sense health practices can go a long way to protecting our children’s health—now and long-term. We do need to be aware of the growing health risks,” she says, “but they can be addressed..

Elizabeth Hamilton, MD, PhD.

Health&Healing: What environmental toxins most concern you as a dermatologist?

Dr. Hamilton: The number one skin toxin is excessive sun radiation. Happily, even as the risk of excessive sun exposure has increased, so has public awareness. I find that parents today are very tuned-in to protecting their children—much more so than they are about protecting themselves. I think that, as far as the sun goes, children are actually going to be much better off as they approach adulthood than we were, because our generation was just not aware of the harm of sun exposure. So, the accumulated sun damage was so intense in our childhood—something today’s children, hopefully, will be spared.

That said, it remains a major challenge to protect ourselves—and our children—from harmful sun exposure. The real problem with the sun is not only its intensity, but the loss of the ozone. It’s great that we’re using sunscreens more regularly, but there are many more ways to approach sun protection—often just a matter of common sense.  

For example, our country hasn’t done as well as a number of other countries in protecting children from the sun. Australia is far ahead of the curve—they’ve adjusted their school day to minimize sun exposure for kids and they’re providing man-made shade. Think about it: our kids go out to play at 3:00 in the afternoon, the very worst time for sun exposure. Outdoor sport practices are all in the early afternoon when the sun is most intense. If schools reorganized their days and had practices and outdoor playtime in the early morning, kids would be much safer.

We forget, too, that clothing is one of the best “sunscreens.” Shade—from an umbrella or tent—is also effective. In fact, the best way to protect babies under six months (who shouldn’t use sunscreen) is to keep them in the shade as much as possible, and to dress them in protective clothing—with a hat with a brim and sunglasses.

H&H: There has been concern expressed that sunscreens themselves may be a source of toxicity; do you see that as a problem?

DR. HAMILTON: Yes, there is an ongoing debate about the toxicity of sunscreens. The concern is about whether absorption of chemical sunscreens—especially over time—poses a health risk.

There are two parts to that. First, is the concern real? The toxic effect of sunscreens has not been determined. I would argue that the limited research that has been done is inconclusive. Some research has found measurable amounts in the bloodstream, but the study only looked at select chemical sunscreens; it didn’t look at blockers like titanium and zinc. Furthermore, they were testing people who were applying it four times a day to their entire body for seven days. The amounts applied were much greater than what the average person applies. To my knowledge, there’s been no documented toxic effect with sunscreens.

Secondly, people too often ignore alternative ways of protecting themselves, such as protective clothing. We’re kind of myopic in that way. “Well, I want to wear my bikini!” and we ignore alternatives. My usual response to adults is that sun protective clothing is not toxic, so if you’re worried about this issue, stay covered up and limit your exposure to chemical sunscreens.

And remember, there’s a difference between chemical and physical sunscreens. Physical sunscreens—which include zinc oxide and titanium dioxide—sit on the surface of the skin to deflect the sun’s rays. Like clothing, they create a barrier against the sun. Chemical sunscreens absorb the sun’s rays like a sponge, preventing the UV radiation from penetrating the skin. So, if you’re concerned about absorption, use the physical sunscreens.

There is one concern about sunscreen toxicity that I do want to point out. And that is the risk involved in using aerosol sunscreens on children. For one thing, it doesn’t offer good protection because most of the product is airborne. But the real worry is about inhalation of sunscreen and propellant. That’s a serious health concern, especially for children. So, it’s recommended that if you use an aerosol, spray it on the hands and then rub it on—which may negate the real benefit of using a spray for some.

H&H: Are you seeing other problems arising from environmental toxins?

DR. HAMILTON: The most dramatic change I’ve seen is how much earlier young girls are going through puberty, with the onset of acne shifting earlier. When I first started practicing about 30 years ago, we would start seeing kids with acne at about 12 to 13 years of age. The new norm now is about 9 to 10 years of age. Two or three years is a big difference—we don’t evolve that fast. So obviously, there are other factors—possibly hormones or antibiotics in the food chain—causing acne to develop earlier. 

We’re also seeing the impact of a different sort of “environmental toxin”—from the commercial “environment.” There has been an extraordinary increase in numbers and kinds of skin care products that are available. Our generation was lucky to have Dove and Ivory soap. Then the first deodorant soap came along, and there were a few creams to moisturize with. Now, half of Walmart’s pharmacy aisles are devoted to skin care products, which are full of additives, such as fragrance. The whole industry has gotten so big, and people want to use it all. While a lot of that may not necessarily be toxic, it is definitely contributing to an increase in the skin problems we see, typically in the form of rashes and allergies.

H&H: What other issues do you encounter?

DR. HAMILTON: I suspect that a big part of the problem is that there’s so much information available—too much information. Who hasn’t Googled their own health care problems? But, often, people don’t have the right context to understand what their problem is. And, frequently, when it comes to skin care, people miss the forest for the trees. There are just so many products out there for people to use. So they’ll use multiple skin products and too often find that they’re problems aren’t getting better. And it’s very difficult to determine which products help and which ones cause problems.

And for parents who are trying to find answers, this can get very confusing, because there’s so much anecdotal information out there. In my experience, in pediatrics, for most skin care issues, less is best.