Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

What Causes My Rash From Sun Exposure?

Thursday, 24 June 2010 09:19 AM

Question: I am no longer able to tan, and even though I use sunblock with an SPF of 25 to 45 each day. If I am exposed to the sun, I will get a rash. When I am exposed two to four hours, I am apt to get 3-6 millimeter lesions that resemble blood blisters on my hands, arms, or legs. They are painful and do not go away after retreating from sun exposure.
One doctor told me that it is PLE (polymorphic light eruptions); another told me that I should just stay out of the sun. Are there any treatments?

Dr. Hibberd's Answer:

Your doctor may be right, but there are other likely causes. PLE is quite common and avoiding triggers is important. Until you find your triggers, you are going to have to limit your sun exposure. PLE is confirmed by skin biopsy and by phototest procedures performed by your dermatologist. Once confirmed, treatment consists of "hardening" by supervised light therapy. Occasionally, oral agents such as psoralens are used in conjunction with the light therapy.

Phototoxicity is more common than PLE. Phototoxicity (a nonimmune reaction to drugs and chemicals) also creates symptoms you describe. Unfortunately, there are no specific tests (unless you choose to do some patch testing), just detective work.

A majority of reactions are caused by drugs or chemicals, or are a combination of substances secreted in your body, such as sweat and oils, that interact with the creams, lotions, and/or soaps you use. They create other compounds and free radicals that react to sunlight and cause phototoxicity and localized skin reactions.

Photoallergy is another consideration that is usually confirmed by photopatch testing. Photoallergy is an immune reaction that will cause generalized intense itching that generally evolves into thickened leathery skin in areas exposed to the sun.

Be sure your doctor has considered porphuria. Porphuria is a rare group of diseases that have various abnormalities in heme, which is a porphyrin and a chemical used to create red blood cells.

Porphyrins are potent photosensitizers. They circulate in the blood diffuse into the skin where they cause skin photosensitivity with subsequent skin rashes. Often the exposed areas become fragile with blisters that rupture leaving a moist, often bleeding, base that heal slowly with crusting and purplish discoloration of the affected skin.

The porphurias are serious conditions that are often misdiagnosed, but they need prompt diagnosis by particular blood and urine tests followed by specific treatment to avoid internal organ damage.

I suggest you eliminate all topical creams, sprays, lotions and soaps. In addition, eliminate all supplements, non-essential prescription, and non-prescription medications. Switch to a hypoallergenic soap like Neutrogena, remove all fabric softeners and change your washing detergent.

Be sure none of the prescriptions you use contain substances known to be phototoxic or photoallergenic. Known phototoxic agents are coal tar topical derivatives, dyes in topical or oral medicines, and many drugs. Many medications are known photoallergic agents as well as sunscreens, whitening agents, and fragrances.

You may use some moisturizing products for skin moisture/dryness control. Eliminate all supplements including vitamins, and take only your essential prescribed medications.

Stop using sunscreen until your skin clears, then test a small area to be sure you are not reacting to the screen itself. There are many different sunscreens available, so you have many choices. Be sure to read the package insert and understand what you are applying to your skin.

Look at your diet. Sometimes certain foods set us up for photosensitivity and rashes. Start by avoiding onions, nuts, spices, and tomatoes, and continue eliminating foods until you achieve success! Re-introduce foods slowly, because sometimes it is a combination of foods that triggers reactions. Remember to request a second opinion if your treatment does not proceed as

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