Summertime safety for skin
Summer First Aid Kit
JONATHAN A. BENJAMIN, M.D.
ROGER W. SPINGARN, M.D.
ELISSA ROTTENBERG, M.D.
KATHLEEN M. CARUSO, P.A.-C
LIZ GRAVES-WITHERELL, P.A.-C
TELEPHONE (617) 244-9929 FAX (617) 244-9935
Summertime Safety for Skin
Sun protection is crucial
It is generally acknowledged that long-term
sunscreen will screen out both ultraviolet B
exposure to sun has a cumulative harmful effect
(UVB) and ultraviolet A (UVA) rays. The sun
. We know that exposure to ultraviolet
protection factor (SPF) should be at least 15.
radiation in childhood, especially early
(Higher SPF values have been known to cause
childhood, increases the risk of developing skin
hypersensitivity reactions and rashes; they are
cancer later in life. Since most of our lifetime
acceptable so long as they do not cause a rash.)
exposure to sun occurs before the age of 18
, it is particularly important to teach our
outdoors. Sunscreens that are "waterproof"
may still need re-application, especially if your child is playing in the water. Zinc oxide, a
The use of long sleeves and pants, a hat with a
very effective sunblock, can be used as extra
wide brim, sunglasses, avoidance of direct sun
protection on the nose, cheeks, tops of the ears,
between 10:00 am and 4:00 pm, and application
and on the shoulders. Lip balm sunscreen can
be used on lips and above eyebrows: it is less
choosing a sunscreen, look for the words
"broad-spectrum" on the label–it means that the
Infants less than 6 months of age should be kept out of direct sunlight. The American
Academy of Pediatrics recommends using sunscreen on small areas of the body, such as the
face and backs of hands, of infants younger than 6 months of age , but only when the skin
cannot be adequately protected with clothing or shade.
Mosquitoes (and other insects)
Mosquito and other insect bites typically are not serious. Most commonly, they itch. Occasionally they become infected when they are scratched, or in the case of some stings, cause an allergic reaction. There are many insect repellants available for use against mosquitoes, no-see-ums, black flies, and ticks (see below); unfortunately none of them are effective against venomous stinging insects.
To relieve the itchiness that accompanies bites by mosquitoes, flies, and fleas, apply Calamine lotion freely onto any part of your child's body except the areas around her or his eyes. If superficial abrasions result from scratching bites, apply topical triple antibiotic ointment (e.g. Bacitracin® or Neosporin®) to prevent infection.
Some individuals can manifest an allergic reaction after being stung by a bee, hornet, yellow jacket, or wasp. Stingers of bees should be removed quickly, minimizing the amount of venom exposure. Use the blunt side of a knife to gently push away the stinger and the attached venom sac, or pull it out with a pair of tweezers (taking care to avoid injecting more venom into the wound). If your child is stung, soak a cloth in cold water or use an ice pack to reduce pain and swelling. Acetaminophen or ibuprofen can relieve the discomfort after a sting. We should be notified immediately of more serious reactions, such as wheezing, nausea, vomiting, or severe swelling.
Note that bug bites in infants and small children can cause impressive swelling and redness, far
more than may be seen in adults.
Using an insect repellant (see box below) is the best way to
prevent this. Swelling that is painful
to the touch may indicate infection and should be evaluated by
Finally, Benadryl® (diphenhydramine) is an antihistamine that can provide relief from severe itching. The appropriate child’s dose is up to
½ teaspoon (6.25 mg) for every 11 pounds, given every 6 hours as needed. Do not exceed 50 mg/dose. Benadryl® is often sedating, but in some individuals (particularly infants) it can be stimulating, causing restlessness and irritability. Lower doses are acceptable.
It is generally acknowledged that the most effective ingredient in insect repellants is DEET
(N,N-diethyl-meta-toluamide). It has been in use for more than half a century, and has a
remarkably impressive safety record. DEET can be harmful if ingested or used incorrectly.
Higher concentrations of DEET increase the effectiveness of the repellant. A concentration of
50% may provide 95% protection for four hours.
The CDC recommends using products that have been shown to work in scientific trials and that
contain active ingredients which have been registered with the US Environmental Protection
Agency (EPA) for use a insect repellants on skin or clothing. Of the active ingredients
registered with the EPA, the CDC believes that two have demonstrated a higher degree of
efficacy in the peer reviewed, scientific literature. Products containing these active ingredients
typically provide long-lasting protection than others: DEET (N,N-diethyl-m-toluamide) and
The CDC notes that definitive studies do not exist about what concentration of DEET is safe for
children. No serious illness has been linked to the use of DEET in children when used according
to manufacturer’s recommendations.
Cream or lotions may be safer for children than aerosol sprays.
Use a DEET-containing repellant only on exposed skin, (not on skin underneath clothing).
Clothing and hats
can be sprayed with repellant, although it may not be recommended for use
on some synthetic materials. Avoid applying it to broken skin, or to hands that may end up in
the eyes or mouth. Take care not to breathe the mist if the repellant is sprayed. When indoors,
wash off repellant with soap and water.
Non DEET-containing products (such as Avon Skin-So-Soft®) may be safer, but were found to
be less effective by Consumer Reports, June 2000.
(Some children may respond better than
They typically do not claim effectiveness against ticks.
Tick bites are generally harmless (causing only
can transmit disease, and a tick can spend hours
local reactions), although they can transmit
on a body without even biting. To remove a
disease. Deer ticks are very small (smaller than
tick, grasp it close to its mouth (close to the
a sesame seed) and in some areas can transmit
skin) with a pair of tweezers and gently apply
Lyme Disease, whereas dog ticks are larger and
away from the skin to remove
do not transmit Lyme Disease. Nevertheless,
all of the parts. If parts are left in the skin, they
the best defense against disease from ticks is a
should be removed if possible, although they
good offense. Wear long pants tucked into
often will fall out on their own if very small. If
socks and long sleeves when in wooded areas
you are in doubt about the tick, save it for us to
or in tall grasses. Avoid tall grass by sticking to
examine. Antibiotics are generally not
the center of trails. Carefully inspect your
recommended for tick bites.
We should be
children for ticks at the end of each day in the
notified if an expanding rash develops at the
site of the tick bite, or your child develops other symptoms.
If you find a tick, don’t panic: ticks must be attached for 36 to 48 hours or more before they
Poison Ivy is a shiny three-leaved green plant. The plant produces a substance that causes an allergic reaction in the skin of susceptible individuals, even during times of the year when there are no leaves
. The rash is usually red, with swelling, and often blisters. It can be intensely itchy, and if scratched excessively, can become infected.
of exposure is clearly the best prevention. Once exposed, however, the best approach is to wash the skin as soon as possible, and launder clothing, shoes and laces, to remove the offending resins. Pet dogs or cats, on the other hand, can maintain resins on their fur and may require shampooing. Once the skin has been washed, the rash does not spread,
even with scratching. The average time for the rash to erupt is 48 hours. The rash can persist for one to three weeks.
The skin reaction develops
like a Polaroid picture. That is, the resin on the plant causes an emerging
allergic reaction in one’s skin. The rash develops first in areas exposed to the most resin, and patches develop later in areas that are less exposed. Finally, note that the fluid in the blisters is not contagious.
Therapy for poison ivy is typically aimed at controlling the symptoms of itch and swelling.
• Calamine lotion is helpful in treating the itch.
• Antihistamines, such as Benadryl® (diphenhydramine) can provide relief from severe itching. The
appropriate child’s dose is up to ½ teaspoon (6.25 mg) for every 11 pounds, given every 6 hours as needed. Do not exceed 50 mg/dose. Lower doses are often helpful and cause less sedation. Topical antihistamines should be avoided. Topical steroids are occasionally used, but they have limited benefit.
• When there is significant swelling, particularly on the face or groin, or there is extensive
involvement, we may prescribe oral prednisone. Please arrange to have your child seen in the office if the reaction to poison ivy is severe or you are concerned about infection.
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