Summer Tips for Staying in the Sun

    For many, the summer means seizing the opportunity to enjoy the outdoors and soak up that well sought after Vitamin D. While the sun often promotes a sense of excitement for those who relish the thought of sunbathing on the beach, it can also represent a source of horror for individuals who suffer from certain sensitivities to the sun.

 

 

    As many individuals are aware of, sunburn is a very common acute reaction following prolonged sun exposure. Malignancies of the skin may also arise following excess sun exposure over many years, as the increased ultraviolet radiation damages and prematurely ages the skin. While these reactions provoked by excessive sunlight are possible amongst all individuals, there are certain reactions to sunlight, known as photodermatoses, which are uncommon, abnormal reactions to ultraviolet radiation that only certain individuals are predisposed to.

 

 

Polymorphous Light Eruption (PMLE)

 

    PMLE is the most common form of photodermatoses with an unknown etiology. Symptoms include itchy skin lesions which develop a few hours to a few days following sun exposure. Symptoms first begin as itchy red patches on the skin which then develop into lesions. The lesions will disappear within a few days following sun exposure and will not leave behind any marks. Many patients with PMLE can develop tolerance throughout the season, meaning it may be possible for them to sunbathe in late August after a tolerance has been achieved. This is why most cases of PMLE are primarily clustered during the beginning of the summer season. The most typical region of the body for lesions to occur are on the upper chest, back of hands, upper arms, thighs, and the side of the face. Despite the fact that one morphology tends to predominate in an individual, the types of lesions characteristic of PMLE tend to vary from macular, papular, papulovesicular, urticarial, or plaque-like, hence the name polymorphous.

 

Solar Urticaria

 

    Solar urticaria is a rare condition in which individuals suffer from the development of pruritic hives immediately following sun exposure. These large hives develop on skin which had been exposed to the sun and can even lead to anaphylactic shock if a large enough area of the skin was exposed. If clothing is thin enough, sun exposure may still cause solar urticaria, even though skin appeared to be covered. Unlike PMLE, solar urticaria typically disappears within 24 hours following sun exposure. Solar urticaria is mediated through the allergy antibody, IgE, as are most allergic conditions such as pollen allergies.

 

Treatment for PMLE and Solar Urticaria

 

    While symptoms are active, treatment with antihistamines may be beneficial in relieving symptoms of pruritus along with a cream containing cortisone. Patients are encouraged to pretreat themselves with antihistamines if they anticipate sun exposure so as to suppress the outbreak of symptoms. Patients can also try applying a cool compress to the area of the lesions in order to provide temporary relief. In both instances, avoidance of sun exposure is recommended and patients are encouraged to cover all body surfaces if they do go outside. This can be done through wearing long sleeves, hats, long pants, sunglasses, etc. For extreme cases, phototherapy, a combination of psoralen and ultraviolet light (called PUVA), or antimalarial drugs may be considered.

 

Phototoxic eruption

 

    Phototoxic eruptions occur in photochemically exposed areas and do not have any immunological basis. These reactions are consistent with dermatitis and symptoms usually appear as sunburn. Phototoxic reactions can occur as a result of certain photosensitizing medications, such as tetracyclines. So while individuals may be able to typically tolerate certain doses of UV exposure, while on the photosensitizing medication they are more likely to develop sunburn-like skin reactions. Treatment of phototoxic eruption involves discontinuing use of all medications and cosmetics which may have led to the photosensitivity. Individuals should only use non-scented sunblock and try to cover body surfaces if sun exposure is anticipated. A combination of 0.1% retinoic acid, 1% hydrocortisone cream, and 5% hydroquinone can be applied to the rash following sun exposure to lessen symptoms.

 

    If you have been experiencing any unusual symptoms following sun exposure which does not respond to typical OTC medications, you should consider scheduling an appointment with your local allergist in order to determine the cause and explore possible treatment options. Regardless of what type of reaction you are experiencing as a result of prolonged sun exposure, application of non-scented sunblock should always be your priority when you anticipate being outdoors. For more information on different conditions related to sun exposure, please follow the link below:

 

 

Weihong Zheng, M.D.