Summer and the Skin: Photodermatoses

It’s finally summer–and time to get outside and enjoy the nice weather! Maybe it’s a beach vacation, sailing, or even watching your kid’s T-ball game. Unfortunately, the sudden increase in UV radiation can result in some uncomfortable skin reactions. While we’re all familiar with sunburns, there are several other photodermatoses that are more prevalent in the warmer months.

The classic “Spring break rash” is also known as polymorphic light eruption. This patient has typically been bundled up all winter and suddenly spends every waking moment in the sun while on spring break in a tropical destination. Within hours to days, a photodistributed dermatitis erupts, often on the chest, dorsal arms, and legs. As the name suggests, there are a variety of morphologies ranging from small flesh-colored bumps, to pink papules, to erythematous plaques and even bullae. Women with lighter skin, ages 20-30, are most susceptible, but it may affect all ages and skin tones. While the etiology is not fully understood, it is thought to be possibly due to UV-induced immunogenicity or delayed-type hypersensitivity. A biopsy and labs may be needed to rule out SLE, cutaneous porphyria, solar urticaria, or other photodermatoses. Topical steroids can relieve associated itching or discomfort.

While examining a new rash, if your first question is, “Have you been drinking margaritas on the beach recently?” there's a good chance you’re thinking about phytophotodermatitis. This occurs due to a phototoxic reaction between the furocoumarins in certain foods and UVA radiation. The most common culprits are limes, lemons, celery, and figs, but several weeds and oils can cause it as well. The rash often presents in unusual geometric shapes, such as handprints or linear “drip marks” with hyperpigmentation, erythema, and occasionally bullae. Common locations are around the mouth, hands, and legs. Treatment is supportive, and discoloration will fade with time.

To prevent various photo-induced rashes from ruining your summer fun, practice safe sun protection, especially during the early Spring and Summer. Apply broad-spectrum SPF of at least 30 or higher and reapply every 3 hours. Avoid direct sun exposure from 10 a.m. to 4 p.m. and wear wide-brimmed hats, sunglasses, and UPF clothing.

Clara Wilson, MS, PA-C, is an experienced Physician Assistant at Trillium Creek Dermatology in Cleveland, Ohio. She is a Diplomate Fellow of the Society of Dermatology Physician Assistants and holds a Certificate of Additional Qualifications (CAQ) in Dermatology. She is also an Adjunct Professor at the Case Western Reserve University Physician Assistant Program. In her free time, she enjoys pilates, playing tennis, and traveling.