Sun Allergy (Photosensitivity)

Sunscreen. Wearing sunscreen may protect your skin from some sun exposure. Researchers have found that UVB rays are more likely to trigger a reaction, so you should look for sunscreens that block those rays. Sunscreens that physically block or reflect the sun may be more helpful than chemical sunscreens, which are formulated to block UVA rays. Ingredients such as titanium and zinc are often effective at deflecting UVB rays and preventing solar urticaria reactions. You should reapply sunscreen frequently while you are outdoors.

What Is Solar Urticaria?

Solar urticaria is a rare allergic reaction to sun exposure. The condition causes an itchy rash or hives that appear on any skin that has been exposed to the sun. The more skin that is exposed to sunlight, the more serious the reaction will be.

There is no cure for solar urticaria. It is a chronic condition that requires daily management, often by staying out of the sun. For some people, protective clothing is sufficient, but other people have to avoid sunlight.

What Are the Symptoms of Solar Urticaria?

The symptoms of solar urticaria are a sudden onset of a rash or hives (solar dermatitis). It may only take a few moments of sun exposure to trigger a reaction. The reaction will usually be confined to skin that is exposed to sunlight. Solar dermatitis symptoms include:

• Blisters or hives
• Many tiny bumps that may merge into larger raised patches
• Pain or itching
• Redness
• Scaling, crusting, or bleeding

In addition to skin symptoms, some people report other symptoms, such as headache, fatigue, nausea, changes in heart rate, and breathing. Symptoms can become worse if large areas of the skin are exposed to sunlight. In rare cases, solar urticaria can lead to anaphylaxis, a potentially life-threatening condition.

The symptoms of solar urticaria usually begin to fade after exposure to the sun ceases. The rash typically clears up within 24 hours, as long as you don’t have additional sun exposure.

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What Are the Causes of Solar Urticaria?

It’s not clear what leads to solar urticaria. Experts believe that it’s an immune reaction. Your immune system mistakenly identifies sun-affected cells as foreign cells. That triggers a histamine reaction, leading to redness, inflammation, itching, and other symptoms.

People of any race can develop solar urticaria, though it is more common in people with lighter skin. It most frequently develops in adults in their mid-30s, and it is more prevalent in women than men. People with other allergies or skin sensitivities may be more likely to develop the condition.

Solar urticaria is very rare. There are only more than 650 cases that have been described worldwide.

What Is the Treatment for Solar Urticaria?

Once you develop solar urticaria, it is usually a lifelong condition. There is no cure for solar urticaria. Preventing sun exposure and managing symptoms are the principal treatments.

Avoid sun exposure. Keeping your skin from direct sun exposure may reduce the frequency of reactions. You can wear clothing that is tightly woven and covers your chest, arms, and legs. Wide-brimmed hats and sunglasses can protect your face. You may be most comfortable staying indoors or in the shade during very sunny times of day.

Sunscreen. Wearing sunscreen may protect your skin from some sun exposure. Researchers have found that UVB rays are more likely to trigger a reaction, so you should look for sunscreens that block those rays. Sunscreens that physically block or reflect the sun may be more helpful than chemical sunscreens, which are formulated to block UVA rays. Ingredients such as titanium and zinc are often effective at deflecting UVB rays and preventing solar urticaria reactions. You should reapply sunscreen frequently while you are outdoors.

Antihistamines. Because solar urticaria is an allergy, allergy medicine can be helpful in controlling outbreaks. Antihistamines control the release of the histamine that causes rashes and inflammation in sun-exposed skin. Your doctor will suggest the medication that will be the most effective. You may need a dose that is higher than usual, so be sure to ask your doctor about the appropriate dosing.

Phototherapy. Your doctor may suggest using phototherapy (short controlled exposures to light) to build a tolerance to the sun. This therapy utilizes the same principle as allergy shots, where you get tiny doses of allergens to desensitize you to them over time. You will need photo-testing to determine how different wavelengths of light affect you. Your doctor will then develop a course of slowly increasing treatments to raise your tolerance for sunlight.

Asthma medication. Some medications that control asthma are helpful for controlling solar urticaria.

Immune therapy. If the standard treatments don’t have the desired effect, you may need immune-suppressing medications to stop the histamine reactions. Research shows that infusions of immunoglobulins or plasma exchange are also helpful for controlling solar urticaria.

In rare cases, solar urticaria goes away completely. Researchers estimate that 15% of people with solar urticaria have a spontaneous recovery 5 years after diagnosis. The likelihood of spontaneous recovery increases to 25% after 10 years.

Managing solar urticaria is complicated. It can have a significant negative effect on your quality of life, since avoiding daylight makes normal activities difficult. Talk to your doctor if you find that your mental health is suffering due to solar urticaria. They can help you find support.

Show Sources

British Association of Dermatology: “SOLAR URTICARIA.”

Harris BW, Badri T, Schlessinger J, StatPearls, Solar Urticaria, StatPearls Publishing, 2021.

Mayo Clinic: “sun allergy.”

Orphanet: “Solar urticaria.”

Sun Allergy (Photosensitivity)

Medically reviewed by Drugs.com. Last updated on Jan 3, 2022.

What Is It?

A sun allergy is an immune system reaction to sunlight, most often, an itchy red rash. The medical term for this condition is Polymorphous Light Eruption (PMLE). The most common locations include the “V” of the neck, the back of the hands, the outside surface of the arms and the lower legs. In rare cases, the skin reaction may be more severe, producing hives or small blisters that may even spread to skin in clothed areas.

Sun allergies are triggered by changes that occur in sun-exposed skin. It is not clear why the body develops this reaction. However, the immune system recognizes some components of the sun-altered skin as “foreign,” and the body activates its immune defenses against them. This produces an allergic reaction that takes the form of a rash, tiny blisters or, rarely, some other type of skin eruption.

Sun allergies occur only in certain sensitive people, and in some cases, they can be triggered by only a few brief moments of sun exposure. Some forms of sun allergy are inherited.

A few of the most common types of sun allergy are:

• Actinic prurigo (hereditary PMLE) — This inherited form of PMLE occurs in people of American Indian background, including the American Indian populations of North, South and Central America. Its symptoms are usually more intense than those of classic PMLE, and they often begin earlier, during childhood or adolescence. Several generations of the same family may have a history of the problem.
• Photoallergic eruption — In this form of sun allergy, a skin reaction is triggered by the effect of sunlight on a chemical that has been applied to the skin (often an ingredient in sunscreen, fragrances, cosmetics or antibiotic ointments) or ingested in a drug (often a prescription medicine). Common prescription medicines that can cause a photoallergic eruption include antibiotics (especially tetracyclines, fluoroquinolones and sulfonamides), NSAID pain relievers ibuprofen (Advil, Motrin and others) and naproxen sodium (Aleve, Naprosyn and others), and diuretics for high blood pressure and heart failure.
• Solar urticaria — This form of sun allergy produces hives (large, itchy, red bumps) on sun-exposed skin. It is a rare condition that most often affects young women.

Symptoms

Symptoms vary, depending on the specific type of sun allergy:

• PMLE — PMLE typically produces an itchy or burning rash within the first two hours after sun exposure. The rash usually appears on sun-exposed portions of the neck, upper chest, arms and lower legs. In addition, there may be one to two hours of chills, headache, nausea and malaise (a general sick feeling). In rare cases, PMLE may erupt as red plaques (flat, raised areas), small fluid-filled blisters or tiny areas of bleeding under the skin.
• Actinic prurigo (hereditary PMLE) — Symptoms are similar to those of PMLE, but they usually are concentrated on the face, especially around the lips.
• Photoallergic eruption — This usually causes either an itchy red rash or tiny blisters. In some cases, the skin eruption also spreads to skin that was covered by clothing. Because photoallergic eruption is a form of delayed hypersensitivity reaction, skin symptoms may not begin until one to two days after sun exposure.

Solar urticaria — Hives usually appear on uncovered skin within minutes of exposure to sunlight.

Diagnosis

If you have mild symptoms of PMLE, you may be able to diagnose the problem yourself by asking yourself the following questions:

• Do I have an itchy rash that occurs only on sun-exposed skin?
• Does my rash always begin within two hours of sun exposure?
• Do my symptoms first appear during the early spring, and then gradually become less severe (or disappear) within the following few days or weeks?

If you can answer “yes” to all of these questions, then you may have mild PMLE.

If you have more severe sun-related symptoms — especially hives, blisters or small areas of bleeding under the skin — your doctor will need to make the diagnosis. In most cases, your doctor can confirm that you have PMLE or actinic prurigo based on your symptoms, your medical history, family history (especially American Indian ancestry) and a simple examination of your skin. Sometimes, additional tests may be necessary, including:

• A skin biopsy, in which a small piece of skin is removed and examined in a laboratory
• Blood tests to rule out systemic lupus erythematosus (SLE or lupus) or discoid systemic lupus erythematosus
• Photo-testing, in which a small area of your skin is exposed to measured amounts of ultraviolet light — If your skin symptoms appear after this exposure, the test confirms that your skin eruption is sun-related.

If you have symptoms of a photoallergic eruption, the diagnosis may take some detective work. Your doctor will begin by reviewing your current medicines as well as any skin lotions, sunscreens or colognes you use. The doctor may suggest that you temporarily switch to an alternate medication or eliminate certain skin care products to see whether this makes your skin symptoms subside. If necessary, your doctor will refer you to a dermatologist, a doctor who specializes in skin disorders. The dermatologist may do photopatch testing, a diagnostic procedure that exposes a small area of your skin to a combination of both ultraviolet light and a small amount of test chemical, usually a medicine or ingredient in a skin care product.

If you have symptoms of solar urticaria, your doctor may confirm the diagnosis by using photo-testing to reproduce your hives.

Expected Duration

How long the reaction lasts depends on the type of sun allergy:

• PMLE — The rash of PMLE usually disappears within two to three days if you avoid further sun exposure. Over the course of the spring and summer, repeated sun exposure can produce hardening, a natural decrease in the skin’s sensitivity to sunlight. In some individuals, hardening develops after only a few days of sun exposure, but in others it takes several weeks.
• Actinic prurigo (hereditary PMLE) — In temperate climates, actinic prurigo follows a seasonal pattern that is similar to classic PMLE. However, in tropical climates, symptoms may persist all year round.
• Photoallergic eruption — The duration is unpredictable. However, in most cases, skin symptoms disappear after the offending chemical is identified and no longer used.
• Solar urticaria — Individual hives typically fade within 30 minutes to two hours. However, they usually come back when skin is exposed to sun again.

Prevention

To help prevent symptoms of a sun allergy, you must protect your skin from exposure to sunlight. Try the following suggestions:

• Before you go outdoors apply a sunscreen that has a sun protection factor (SPF) of at least 30 or above, with a broad spectrum of protection against both ultraviolet A and ultraviolet B rays.
• Use a sunblock on your lips. Choose a product that has been formulated especially for the lips, with an SPF of 30 or more.
• Limit your time outdoors when the sun is at its peak — in most parts of the continental United States, from about 10 a.m. to 3 p.m.
• Wear sunglasses with ultraviolet light protection.
• Wear long pants, a shirt with long sleeves and a hat with a wide brim.
• Be aware of skin care products and medicines, especially certain antibiotics, that may trigger a photoallergic eruption. If you are taking a prescription medication, and you normally spend a great deal of time outdoors, ask your doctor whether you should take any special precautions to avoid sun exposure while you are on the drug.

Treatment

If you have a sun allergy, your treatment must always begin with the strategies described in the Prevention section. These will reduce your sun exposure and prevent your symptoms from worsening. Other treatments depend on the specific type of sun allergy:

• PMLE — For mild symptoms, either apply cool compresses (such as a cool, damp washcloth) to the areas of itchy rash, or mist your skin with sprays of cool water. You can also try a nonprescription oral (by mouth) antihistamine — such as diphenhydramine or chlorpheniramine (both sold under several brand names) — to relieve itching, or a cream containing cortisone. For more severe symptoms, your doctor may suggest a prescription-strength oral antihistamine or corticosteroid cream. If these remedies are not effective, your doctor may prescribe phototherapy, a treatment that produces hardening by gradually exposing your skin to increasing doses of ultraviolet light in your doctor’s office. In many cases, five ultraviolet light exposures are given per week over a three-week period. If standard phototherapy fails, your doctor may try a combination of psoralen and ultraviolet light called PUVA; antimalarial drugs; or beta-carotene tablets.
• Actinic prurigo (hereditary PMLE) — Treatment options include prescription-strength topical corticosteroids, phototherapy with special ultraviolet rays, and potentially thalidomide for severe cases.
• Photoallergic eruption — The first goal of treatment is to identify and eliminate the medicine or skin care product that is triggering the allergic reaction. Skin symptoms usually can be treated with a corticosteroid cream.
• Solar urticaria — For mild hives, you can try a nonprescription oral antihistamine to relieve itching, or an anti-itch skin cream containing cortisone. For more severe hives, your doctor may suggest a prescription-strength antihistamine, a topical or oral corticosteroid preparation, and/or phototherapy..

When To Call a Professional

Call your primary care doctor or a dermatologist if you have:

• An itchy rash that does not respond to over-the-counter treatments
• A rash that involves large areas of your body, including parts that are covered by clothing
• A persistent rash that covers sun-exposed areas of your face, especially if you are a woman or a person of American Indian heritage
• Abnormal bleeding under the skin in sun-exposed areas

Call for emergency help immediately if you suddenly develop hives together with swelling around your eyes or lips, faintness or difficulty breathing or swallowing. These may be signs of a life-threatening allergic reaction.

Prognosis

If you have a sun allergy, the outlook is usually very good, especially if you consistently use sunscreens and protective clothing. Most people with PMLE or actinic prurigo improve significantly within five to seven years after diagnosis, and almost everyone with photoallergic eruption can be cured by avoiding the specific chemical that triggers the sun allergy.

Of all forms of sun allergy, solar urticaria is the one that is most likely to be a long-term problem. However, in some people the condition eventually subsides.

Additional Info

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

American Academy of Dermatology
http://www.aad.org/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Mum shares photos of baby boy’s agonising burns after shocking cause discovered

A COMMON food has left a baby boy with some agonising burns, a mum has warned.

Sharing the pictures on her little boy online, the mum is calling on parents to be on the look out for the little-known condition.

Little Otis was playing with a lime while sat outside in the sunshine with his cousins, the mum explained in a Tiny Hearts Education post on Instagram.

“It wasn’t until [the next day] that we noticed a rash appear on his chest,” she said.

The rash, which the parents initially thought was an allergic reaction to the lime juice, quickly developed into a “horrific burn”, she added.

The parents took Otis to the hospital, where doctors revealed the little boy was suffering with a little-known condition called phytophotodermatitis.

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Phytophotodermatitis – more commonly known as margarita burn – is a burn which happens when a chemical called furocoumarin reacts with sunlight.

This chemical is found in limes, citrus fruit and some plants.

“We now have ongoing appointments with our local paediatric burns team for ongoing management to ensure no long-term scaring and implications,” the mum said.

“I hope by sharing my story I can raise some awareness about phytophotodermatitis and the importance of watching little ones around any citrus fruits,” she added.

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One user wrote: “Oh my goodness, how scary! Thanks for sharing and I hope Otis is on the mend.”

Another said: “I had no idea. Hope your little man is ok and thanks for sharing.”

One user shared her experienced of phytophotodermatitis: “I once had what looked like hickeys over my neck and wrists.

“It took me a couple of days to do some research and find it was the citrus perfume I had sprayed on and then gone into the sun – it left ugly marks on me for months.”

How to prevent phytophotodermatitis

It’s important to remember that not everyone will experience phytophotodermatitis after exposure to furocoumarin.

But your little one may be at a greater risk if you have a history of contact dermatitis with other substances, such as metals and cleaning agents.

According to Healthline, here is how to prevent the burn from occuring in both adults and children:

• Wash your hands and other exposed parts of the skin immediately after being outdoors
• Wear gloves when gardening
• Wear pants and long sleeves in wooded areas
• Put sunscreen on before heading outdoors (prevent rash from exposed hands)

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