Heatwave sunscreen advice based on 20-year-old report 'puts children at risk'

UKHSA and DHSC advice to use SPF 15 falls short of NHS recommendations as temperatures soar
The NHS and British Association of Dermatologists recommend using sunscreen of at least SPF 30. Photo: chezbeate/Pixabay

Skincare experts have warned the latest government guidelines for protecting children from the sun amid this week's heatwave are inadequate and “put people at risk”.

Guidance published by the UK Health Security Agency, the Department of Health and Social Care and NHS England – which appears to be based on a two-decade-old report – advises teachers to “use sunscreen (at least factor 15 with UVA protection) to protect skin if children are playing or taking lessons outdoors for more than 20 minutes”, in combination with other protective measures.

The guidance was published on 15 July ahead of this week’s heatwave, which has seen temperatures top 38C in parts of the UK so far.

But experts have told CSW the advice on sunscreen – which falls short of NHS and British Association of Dermatologists’ recommendations to use at least SPF 30 and includes no instructions for proper use – is "woefully inadequate" .

A UKHSA spokesperson told CSW the advice was partly informed by a report from the National Radiological Protection Board – which was dissolved in 2005. The 2002 report suggests "an SPF of 15 or higher should be more than adequate for all-day exposure if properly applied".

By contrast, the NHS recommends children and adults use at least SPF 30, and stresses that sunscreen must be applied “liberally and frequently” to remain effective.

Asked why a 20-year-old report from a long-defunct organisation was used as the basis from the advice, rather than more recent research or publications, a UKHSA spokesperson said the evidence and data in the report has been reviewed since publilcation and remains scientifically accurate.

The guidelines “put people at risk”, skincare expert Caroline Hirons told CSW. “It’s really that simple.”

“How can we expect our young people to take us seriously when we talk about sun protection while the recommendations from a lot of ‘official’ bodies are still ‘wear SPF 15’? The average skin in the UK is between Fitzpatrick 1 and 2 [lighter skin pigment with a high likelihood of burning], making them the most at risk for skin cancers. If someone in that demographic applies an SPF 15 in the morning, any protection they have will be gone by lunchtime,” she said.

“I do not know a dermatologist that recommends below an SPF 30 for general use, and below an SPF 50 for extreme weather, such as we are experiencing now in the UK – and it’s always, without fail, SPF 50+ for small children.”

SPF – sun protection factor – indicates how much longer it will take someone to burn in the sun after applying sunscreen, compared to using none at all.

SPF 15 products “do provide sufficient sun protection”, but only when used correctly and regularly reapplied, Dr Bav Shergill of the British Association of Dermatologists says. 

“In real-world scenarios people almost never apply the right amount of sunscreen, which is why we, and other organisations, including the NHS, recommend a minimum of SPF 30. Studies have found that most people apply less than half of the amount required to provide the level of protection indicated on the packaging,” Shergill told CSW.

“Ideally, all sun protection advice should take into account how sunscreen is used in the real world,” he added.

CSW understands some schools, informed by the official advice, have advised parents to apply sunscreen of at least factor 15 before school because children will not be able to reapply it during the daytime.

British Skin Foundation spokesperson Eleanor Lloyd added that it is “vital to protect children’s skin from the sun by generously applying a sunscreen with a minimum SPF 50 and at least 4 stars for UVA protection and reapplying every two hours or after swimming or sweating”.

“We know children love spending time outdoors, however, their skin is more delicate than an adult’s and can easily be damaged by the sun,” she said.

Both BAD and the BSF stress that sunscreen should be the last line of defence on top of other protective measures like loose clothing and staying in the shade.

The guidance, which is being promoted by other ministries including the the Department for Education, says children should not take part in “vigorous physical activity” on very hot days; that they should wear loose, light-coloured clothing; and that they should be encouraged to stay in the shade as much as possible.

Skincare expert and aesthetician Dija Ayodele told CSW the advice is “not adequate, neither is it appropriate”.

“The minimum sunscreen that children should be wearing is SPF 30, not SPF 15, and neither should children only be applying sunscreen in the morning before school. Sunscreen should be applied throughout the day, especially if children or grown ups are active and running about and sweating. We normally say apply sunscreen every two hours, slightly more if children are active," she said.

Ayodele has called for the introduction of sunscreen stations at schools to enable children to reapply sun protection during breaks.  "It is wholly inadequate, bottom line for children to only have sunscreen applied at home before they go to school, especially in this sort of weather," she said.

She said the advice also lacks nuance because it fails to address the common myth that only people with pale skin need to wear sun protection.

"Children who are black or of Asian descent, for example, also need to have sunscreen application, especially in this sort of weather... so [the advice] definitely does need to be updated and even with ethnic minorities, the sunscreen advice would still be a minimum of SPF 30," she said.

Ayodele said she would expect civil servants to have expert input when drafting advice on sun safety, "but it could be that it just needs to be updated and they need much more up to date research to inform the papers that they are writing and the advice that they are given". 

She said departments should also speak to experts who have experience of working to include ethnic minorities in conversations on sun safety, as well as teachers when drafting the advice.

Dr Michael Higlett, senior radiation protection scientist at the UKHSA, told CSW: “The most important aspect of protecting yourself with sunscreen is to make sure that it is applied liberally and frequently in line with the manufacturer's instructions. Higher factors will provide more protection if applied properly, but a factor of at least 15 offers suitable protection providing it is applied properly.

“Applying sunscreen is not the only way to keep safe – staying out of the sun when UV rays are at their strongest between 11am and 3pm, and wearing suitable clothing such as wide-brimmed hats and wrap-around sunglasses, are also important steps you can take in warm conditions.

“This advice is consistent with guidance from the World Health Organisation.”

CSW asked UKHSA why the information about sunscreen application provided in response to our queries was not included in the guidance for to teachers and others responsible for childrens’ safety. The agency did not provide a response.

Asked how the guidance was formulated and which experts were consulted, a UKHSA spokesperson said it was informed by evidence on the health effects of UV radiation and a report from the NRPB – which was disbanded when its functions were absorbed into Public Health England, UKHSA’s predecessor organisation, in 2005.

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