Improving the sun safety of bicycle helmets.

To the Editors: The incidence of sun-induced skin cancer is rising and the eyelid and face are frequent sites of involvement.1,2 Sun exposure can also predispose to pterygium, climatic droplet keratopathy, cataracts, and perhaps macular degeneration. The majority of the skin’s lifetime sun damage occurs during childhood.2 More than 70% of American children ages 5 to 14 years (27.7 million children) ride bicycles and this age group rides 50% more than the average bicyclist.3 Thus, significant sun exposure can occur when children ride a bicycle. Improvements to helmet design can supplement the facial sun protection offered by wide-spectrum sunscreens and sunglasses. Sunscreen is useful but suboptimal because it cannot be applied near the eyelid margin, should be ideally applied 30 minutes before going outside, and should be reapplied after sweating.4 Sunglasses provide excellent periocular protection, but do not protect the rest of the face. Many children’s bicycle helmets do not have visors (Fig. A). When clip-on visors are available on a bicycle helmet, they usually do not provide optimal shade protection. Hats or visors worn underneath helmets usually offer more effective shade protection than helmet-clipped visors that are positioned higher on the helmet (Fig. B). The lower position of the hat or head-worn visor usually does not impede vision in children who ride at slower speeds in an upright position, but occasionally the hat or visor may slip. The use of hats or visors under helmets may compromise the fit of the helment, and the helmet padding may have to be altered to retain the proper fit. Hats may decrease ventilation, making children feel hot. Children may complain of ear discomfort if the edges of the hat or visor are pushed down by the helmet. A better alternative to hats or visors is specially designed helmet covers with a low-riding front ledge to protect the eyes and face and a back flap to protect the ears and neck (Fig. C). The central mesh fabric does not impede helmet ventilation as much as a typical hat and will not affect the fit of the helmet. The helmet cover is available in high visibility colors for safety. However, this helmet cover costs more than many children’s helmets (Adventure Cycling Association; http://www.adventurecycling. org/store/index.cfm). The paramount safety concern with bicycle helmets is to protect against head trauma, and much thought has gone in to the design of bicycle helmets for crash protection.5 However protection from the sun is a neglected helmet safety consideration, likely because of the long latency before skin cancer or eye damage occurs. Sun safety education can do much to prevent skin cancer and solar eye damage in our pediatric patients6 and is advantageous from a cost–benefit and cost-effectiveness perspective.7 The combination of sunscreen, sunglasses, protective clothing, and minimizing outdoor activities during times of