Monthly Archives: May 2019

Sun protection and awareness

Sun Awareness

Skin protection

1.  Sunscreen -is our most important ally in protecting our skin from the dangerous sun damage if used correctly. However,  government studies have raised concerns regarding ingredients found in the most common sunscreen lotion protection products. The most commonly used sun protection ingredients might be having a dangerous effect on our skin by causing an acceleration of skin damage leading to skin cancer. These harmful ingredients include Vitamin A ( retinyl Palmitate), and Oxybenzone. Recently a study showed that in addition to the dangers to the skin of these ingredients in sunscreen others including avobenzone, octocrylene, and ecamsule and oxybenzone in the previous warning , have been found to be absorbed from the skin into the bloodstream in as little as 3 hours;  reaching toxic levels lasting up to 3 days.

It is also not recommended to use sun protection products that include insect repellant. These are commonly found in the most marketed and widely accepted products available. Also Sprays, Powders, and any designation of a SPF above 50 are not recommended.

Creams and lotions are the most reliable and safest form to apply suntan protection

Ingredients to look for that are safe and valuable as sun protection include Zinc oxide and Titanium Dioxide,.Some of the products that have been rated the highest and are considered to be safe include Jason’s Natural Cosmetics, Organic Desert essence, California Baby, Badger, and All Terrain. Other factors to consider include water and sweat resistance. An SPF of 30+ is recommended. Anything above that is not considered reliable. My preferred product is “Cotz” sunscreen sensitive skin products particularly if you have sensitive skin or eczema.

2.Skin care in the heat -those with sensitive skin can get flushed and develop heat rashes –  In the summer we need to take care of our children’s skin especially with the increased humidity and drying effect of swimming. Everyone should, especially anyone with eczema, use moisturizer 2 x a day, and apply a generous coating after rinsing off from the pool or beach as well as the shower. Sweating, particularly in areas of contact with surfaces like car seats, makes skin more irritated. It also may cause preservatives and detergents to leach out from clothing. Be especially vigilant with angles of the body like behind the knees and elbows. Try to wear looser fitting clothing made out of cotton and washed with gentle allergy free detergent like those you used for your baby.

3.Clothing- The best protection is by covering as much exposed skin from the sun as possible. Light weight, sun shielding clothing is recommended. In addition a hat and sunglasses are a must for everyone at all ages. Also a hat is important to protect your face and eyes from sun damage

4. Timing- Try to stay out of direct sunlight as much as possible, but if you do go in the sun go during the cooler part of the day; generally before 11 AM and after 4 PM. I try to not go out in direct sunlight before 7-7:30 AM and after 7 PM particularly in the summer months when the sun is the strongest

Additional Summer Sun precautions

1.       Dehydration- happens a lot faster in the summer sun- for most of us dehydration sneaks up on us after being in constant heat without drinking liquids for extended periods of time. Always hydrate before, during, and after all summer activities. This is especially true when we or our children are swimming. It is easy to forget to drink enough when you are in the pool feeling comfortable and cool. Make sure you give your children plenty of fluids before swimming and take “water breaks” like you would if they were playing a sport. Early signs of dehydration- general fatigue and weakness , tired, headache,  parched lips, thirsty, dry skin, skin flushing, chills, dark colored urine- Always keep water and electrolyte solution with you this time of year. Be sure to send an extra bottle of water with your child to school

2.       Eye protection– parents should educate their children regarding sun dangers particularly as it intensifies in the summer. This includes wearing a hat and sunglasses- sunglasses should have a large lens or wrap around frames. They should block 100% of UV rays and absorb most of HEV rays. Make sure they are inspected and are impact resistant. ( Be careful with inexpensive party favor glasses that may break while your child is wearing them)

3.       Surface danger-any surface that has been out in the summer sun for extended period of time could cause burns and skin damage.

a.    Car surfaces are particularly susceptible since much of it is metal. From the door to the buckle on the seat belt, little hands can get burned easily. Be careful of things left in the car as well, like games and toys. Anything with metal components may burn your child when they go to play with it. Cover your car windows when you have to park your car directly in the sun.

b.   Pool and beach- the area around the pool particularly the edge is very hot and can cause burns on little hands and feet when a small child is holding onto the side of a pool and do not realize they are getting burned while they are cooling off in the water. Of course the sand on the beach is hot, but so is anything you bring with you and leave out in the sun before your child plays with it from cups to toys.

c.    Park and playground-benches, monkey bars and other park and sports equipment are always hot and can cause skin irritation and burns. Try to find parks with shade coverage unless you go in the early morning or late afternoon.
4.Unattended in car-Never leave children in the car unattended even for short periods of time.  You will always underestimate the effect and may get delayed. Take the extra step- either spend time taking your child with you for the errand even if it is a brief outing. Plan ahead and think through your decision to bring your child with you in the first place.

Warren Krantz MD, HealthfulMD

Insect repellent guidelines

Insect repellent guidelines and recommendations

I had published an article evaluating insect repellents about 5 years ago . The main ingredient I have consistently recommended to prevent insect bites has been Picaridin. It is still difficult to find in stores and for the most part has to be ordered online.

In addition since most people travel in the summer months and many to areas now considered high risk for lime ticks it is essential to know which products cover these as well. The high picaridin concentration products also are effective against ticks as well. Permethrin is considered the most effective ingredient for tick avoidance. However, Permethrin is not as safe to place directly on the entire body and should be applied to clothing only.

Tips to avoid mosquitos 

Place a large fan by each doorway, Mosquitoes cannot fly past a strong wind force.

Spray all your plants and areas that are breeding grounds . there are many natural products that several companies are using to spray in our yard.

Empty all containers outside that contain water to avoid the mosquito breeding

Mosquito lights ( zappers) and fans to attract them work in a restricted area . Several brands are popular including dynatrap which I have found to be effective.

My recommendations for products you can easily purchase

Sawyer 20% Picaridin spray or lotion

Repel -15% Picaridin – ( Has a red Label and says Tick defense but is the same for Mosquitoes  ) Available in Target and Walmart.

Natrapel – 20 % Picaridin

Wipes – Natrapel 20% Picaridin

Fan- place a large fan at your entrances angled to keep the mosquitoes from flying into the house. Or around the area where you plan on sitting in the yard.

Lime tick preventionSawyer permethrin

Top products recommended by Consumer Reports

Sawyer Fisherman’s Formula – 20% Picaridin

Natrapel 8 hour- 20 % Picaridin

Off Deepwoods V111- DEET 25 %

Repel Lemon Eucalyptus  Oil of Eucalyptus 30 %

2019 update to insect repellent for mosquito protection. As before, I used Consumer Reports ratings and suggestions as my starting point for recommendations. This time there is added emphasis on the most successful protection with less concern regarding  type of spray- organic or not . Similar to last review “ Picaridin “ ingredient comes in first across the board for both effectiveness and least toxic to you and your children weighed against this effectiveness. Over the years I have tested most products since I am a personal mosquito feast. The organic and natural products do not work for me and their smell was so noxious that family and friends and my dog stayed away from me but the mosquitoes  were hardly deterred .In addition many of these “ natural and organic” products have not been tested by the FDA and really can not be verified for safety, quality, ingredients,  or effectiveness. With the Zika virus making the stakes higher than ever to prevent mosquito bites all individuals involved with caring for children and preventing disease are more strongly than ever recommend products that work effectively rather than are most natural. Fortunately , in this case the one I have found to be most tolerable across the board Picaridin is the most effective and least irritating.

In addition with consideration to the environment Picaridin also rates highly. Many of the organic and natural products would have contaminating effect on the environment in the concentrations necessary to garner any substantial repellent activity. But in this instance they do not offer enough protection against the Zika virus mosquito to warrant serious consideration. DEET has been found in streams and rivers and shown to have some impact on wildlife. Taking effectiveness , toxicity to children, and least possible environmental impact I recommend “ Picaridin” as my first choice in insect repellent.  The only difference , the products that have been previously recommended do not have a high enough percentage of Picardin in their solution. 20 % seems to be the concentration that works the best in the Consumer Reports testing and ratings . The brands which were the most effective were Sawyer Fisherman formula Picaridin, Naturapel; 8 hour with Picaridin, . Deepwoods off with 25 % DEET was as effective against mosquitoes but not ticks, but I do not recommend that strong of a percentage of deet for children. Repel lemon eucalyptus 30% was the only non Picaridin based repellent rating as high but the smell is difficult to tolerate and it’s irritating to the skin and eyes to the point that it is not recommended for anyone under 2.  

Insect protection and repellent guidelines.

  1. The ingredients proven the most effective and with the longest history of safety is Deet. Picaridin has been studied for 15 years and has proven to be safe and is less irritating especially to children with sensitive skin. Oil of Eucalyptus has proven to be moderately effective as well.
  2. Children under 2 months of age should not receive any topical insect repellent. [ Use mosquito netting to prevent any access to babies ]
  3. Oil of Eucalyptus should not be used on any children under 2 years of age due to the concerns regarding possible eye irritation.
  4. Apply it to your hands and then rub them on your child. Do not spray it anywhere near a child to avoid inhalation of fumes. In the case of Permethrin for lime tick prevention do not put it directly on your hands before spraying it on your child’s clothes and shoes.
  5. Do not apply it to a child’s hand, they may put them in their mouth.
  6. Adults should do the applying for young children.
  7. Apply to clothing first and foremost to avoid unnecessary skin irritation. Do not apply it under clothing.
  8. Apply sunscreen first before adding insect repellant.
  9. Sunscreen and insect repellent mixture is absorbed in a higher degree and not recommended.
  10. Be careful applying to cuts wounds, and after shaving. It can be absorbed more readily.
  11. The percentage of each ingredient correlates to the time spent outdoors. 10 % is usually sufficient. However, now we recommend Picaridin 20 %.
  12. There has been no reported serious illness regarding the use of these ingredients in children.
  13. The recommended ingredients are safe for pregnant women, breastfeeding moms, the elderly, and babies older than 2 months of age.
  14. Natural products that have proven moderately successful include Avon “Skin so Soft”, California Baby, and Burt Bees. And some essential oils tend to be helpful including cinnamon oil, eucalyptus oil, citronella oil, peppermint oil,  lemongrass and rosemary. However, in the recent Consumer Reports review none of these natural style products were effective against the Zika carrying mosquitoes .
  15. Remember to reapply according to the instructions on the package .
  16. Pay attention to any skin irritation in areas where you apply the repellant.
  17. Should wear long sleeves and long pants this year. Collared shirts give more protection.
  18. Shoes – be very cautious with open toed sandals and crocs.
  19. Hat- hats offer protection not only from the sun but also keeping mosquitoes off your face and scalp. Can spray the hat before putting it on to offer even more protection.
  20. Try to avoid early morning and dusk through the night time without complete protection described above.
  21. Don’t spray near food and wash your hands before eating.
  22. Do not go to sleep or get in your bed before washing off the insect repellent.

Make your own natural insect repellent ( have not been proven to be as effective as the recommended picaridin products.

Base: Calendula cream – 4 0z -has repellent qualities as well

Cinnamon leaf oil -about 20 drops or 3 ml

Peppermint oil – 20 drops

Rosemary oil 10 drops

Lemongrass oil  20 drops

lavender oil – 20 drops

( I avoid citronella and eucalyptus even though they are he most effective ingredients because of their strong odor and irritating quality on the skin.

Deet  products are the highest rated-for most effective by consumer reports for all concentrations .  I tend to add  smell and feel to the list of important criteria in selecting an insect repellant.

Consumer reports ranked Deep woods Off, Cutter Backwoods, and Off family care the most effective at 98% with Cutter Backwoods unscented and Off Family care smooth and dry much more tolerable for feel and smell to me. They all last up to 8 hours and keep mosquitoes away well. However, due to the higher percentage requirement for DEET for the Zika carrying mosquito , I prefer we avoid DEET at those levels.

Picaridin– the product I use the most has a similar effectiveness. Previously I have recommended the the lower percentage of products by Off and Cutter advanced which contain 5-7 % Picaridin. These two products have worked well for me in Florida as well as while hiking in Mosquito infested areas. Consumer reports ranked Natrapel which has 20% Picaridin very highly at 97 %. And now with the concern with a more vigorous mosquito carrying the Zika virus , based on Consumer Reports findings , the higher percentage is now recommended.

Permethrin – used in treating lice on the hair and body is a good tick repellent. It should be handled carefully and applied to clothing and shoes when going out in areas known for deer ticks.

Avon skin so soft has a smell and feel that I have never been happy with. It is ranked as more effective than organic products at 73% by consumer reports.

Lemon Eucalyptus– ( for instance Repel ) works well but the smell is generally intolerable to others. In my experiment I had to walk and jog by myself by at least 10 feet due to the annoying smell to other people in my party. My dog would not go near me or any room that had the clothes sprayed with Eucalyptus. This is not recommended for children under 2.

Organic products- based on plant oils generally are considerably less effective as a group .Bite Blocker  had a 56 % rating and Burt’s Bees had a 24 % rating compared to the recommended products effectiveness by Consumer reports.

Off ” clip on repellent”– the off “fan” that clips on and distributes a fine mist of repellent by fan is moderately effective if you are still for long periods of time. It is not nearly as effective if you are moving or walking. There is a warning on it to not breathe in the fumes, which is not really possible especially for children. In addition to these findings by Consumer Reports it tends to not last nearly as long as it states on the package. I have used it for sitting in the backyard and it helps keep the mosquitoes away, but I would not recommend it for small children.

Stickers and bracelets – have been successful for many parents. I have tried them on my collar ( one on each side to avoid putting on repellent and they have moderate success in avoiding mosquito bites.

Warren Krantz MD