Allergy to the sun - photodermatitis (photodermatosis) and its prevention

Information about a number of other diseases: Basal cell carcinoma, Graves' disease, Balanitis, Delirium tremens, Beriberi, Infertility in women, Infertility in men, Insomnia, Rabies, Blepharitis, Myopia, Bundle block, Addison's disease, Alzheimer's disease, Bowen's disease, Von Willebrand's disease, Gunter's disease, Cushing's disease, Crohn's disease, Parkinson's disease.

What is Gunther's disease?

Gunther's disease is a fairly rare hereditary disease, during which disruptions in pigment metabolism and accumulation of porphyrin in the soft tissues begin. This substance has a nitrogen-containing pigment, included in hemoglobin, which gives blood cells the red tint familiar to people. The process begins development in the red bone marrow, interconnected with the action of red blood cell synthesis.

Dangerous sun

The sun's rays that reach the surface of our planet consist of 40% visible light, 50% infrared radiation and 10% the most dangerous ultraviolet (UV) radiation.
In turn, the latter are divided into short UVC, medium UVB and long UVA. Among them, UVA rays have the most aggressive effect on the skin, causing redness and burns6. They penetrate into the deepest layers of the skin and can cause various changes in their cells (fibroblasts, endothelial cells, granulocytes)7. Protection against photodermatitis

• Before going out into the open sun in spring and summer, it is better not to use deodorant or perfume.
• 20 minutes before going outside, apply a cream with a high level of UV protection to exposed skin.
• Before taking a new medicine, check to see if it contains any ingredients that cause photoallergy.
• Sunbathe by first applying sunscreen to your skin. After water procedures, pat your skin with a towel so that the cream remains on the skin.
• If possible, limit exposure to open sun. Wear thick clothing that covers most of the body, and wear wide-brimmed hats.

How to detect?

The first symptoms indicating the presence of Gunther's disease begin to appear already in the first year of the baby's life. In special situations, they may occur several years later. The main symptoms of the presented process include:

• Scarlet color of urine, caused by a large amount of pigment in the body;
• Colored tooth enamel, which is evidence of the deposition of porphyrins on the teeth;
• Chronic photosensitivity is a process during which a burn may appear in the patient’s body due to the penetration of ultraviolet radiation through glass. Causes rashes;
• High level of hair on the epidermis;
• Significant growth of the liver and spleen;
• Destruction of red blood cells in the circulatory system.

Symptoms of photodermatosis

I am allergic to meadow grasses. On sunny days, a few hours after a walk, an itchy rash sometimes appears on the hands. Is this a symptom of photodermatosis or hay fever?

In general, pollen is a greater irritant than the sun. A reaction to pollen can occur almost instantly. And photodermatosis is a delayed reaction: symptoms appear after some time. In addition, pollen allergies rarely cause skin problems. More often these are respiratory manifestations: nasal congestion, sneezing, lacrimation, coughing. While photodermatosis, as a rule, manifests itself as skin problems. However, an accurate diagnosis can be made only after examination by an allergist and allergy testing.

How to cure?

Currently, scientists have come to the conclusion that it is impossible to fully recover from this condition. However, it is possible to reduce the number of relapses. In addition, doctors in some cases use bone marrow transplantation. Doctors advise people suffering from Gunther's disease to spend a minimum amount of time in the sun. The following are used as braking:

• Nicotinic and ascorbic acid;
• Riboflavin;
• Cyanocobalamin.

What consequences can the disease lead to?

According to clinical data, such a disease can cause numerous metabolic problems in the patient’s body. All patients live for a short period of time.

Allergy to the sun - photodermatitis (photodermatosis) and its prevention

The sun's rays not only warm us with their warmth in spring and summer and make us happy in winter, but also help strengthen our immune system. But, unfortunately, exposure to the open sun can cause an allergic reaction in some people.

Sun allergy, photodermatitis (photodermatosis) are diseases caused by increased sensitivity of the skin to sunlight. This is not at all a rare occurrence. Statistics show that about 20% of people worldwide experience this disease.

Sun allergy actually refers to photodermatitis or photodermatosis. The toxic or allergic effect of the sun occurs when the sun's (ultraviolet) rays interact with any substance located on the skin (exogenous photodermatitis) or in the skin (endogenous photodermatitis).

Allergy to the sun in the form of exogenous photodermatitis

The most striking example of exogenous photodermatitis is the so-called meadow dermatitis. In summer, during the flowering period, many meadow plants secrete special substances - furocoumarins, which settle on the skin when a person is in these places. With simultaneous exposure to ultraviolet radiation, some sensitive people may experience skin redness and blisters (erythema, vesicles, bullae). The rash is accompanied by severe itching. Subsequently, long-term pigmentation remains on the affected areas of the skin.

An allergy to the sun or photodermatitis can also occur if, before going out into the sun, a person sensitive to it applied cream or ointment, or used perfume and deodorant. Substances contained in various cosmetics or perfumes can react with ultraviolet rays and cause an allergic reaction. Such properties are possessed, for example, by eosin, which can be contained in lipstick, and para-aminobenzoic acid (PABA), which is part of some sunscreens. In addition, polyunsaturated fatty acids, retinoids, bergamot oil, St. John's wort, rose, musk, sandalwood, dill juice, parsley, boric acid, salicylic acid, phenol, and mercury preparations have a similar effect.

More often than others, people with fair skin and young children, whose skin defense mechanisms are much weaker, suffer from sun allergies.

Photodermatitis is often caused by many medications. This effect is exerted, in particular, by sulfonamides, barbiturates, aminazine, some antibiotics (doxycycline, tetracycline), antihistamines, some cardiovascular drugs (amiodarone, Trazicor), cytostatics, some non-steroidal anti-inflammatory drugs (ibuprofen, aspirin), and oral contraceptives.

In addition, an increased reaction of the skin to the sun's rays appears when the skin is “weakened” by some additional influence - peeling, tattooing using cadmium salts.

Allergy to the sun in the form of endogenous photodermatitis

This group of photodermatitis includes quite rare diseases, in the development of which disturbances in the functioning of the body’s immune system, as well as various metabolic disorders (metabolic disorders), play an important role. Endogenous photodermatitis includes, in particular, porphyria, xeroderma pigmentosum, solar eczema, solar prurigo, Hydroa vacciniformia, polymorphic photodermatosis.

Typically, these reactions can occur by two mechanisms: 1) a phototoxic reaction and 2) a photoallergic reaction. Phototoxic reactions are much more common than photoallergic reactions.

How does sun allergy or photodermatitis usually manifest?

The main symptoms of photodermatosis:

• redness and inflammation of the skin,
• peeling of the skin,
• often accompanied by intense itching and burning,
• rashes can be in the form of folliculitis (pustules) or papules.

Often this condition does not develop immediately. Unlike a burn, it can occur several hours after you leave the beach, and in some cases even after returning from the resort. A phototoxic reaction can occur within a few hours of sun exposure, while a photoallergic reaction can occur even days after sun exposure.

Increased risk of developing sun allergies:

• in people with naturally light skin;
• in pregnant women;
• in young children;
• a number of medications can make skin burns faster - these include tetracycline antibiotics, sulfa drugs, painkillers, etc.;
• who has relatives with sun allergies. There is a greater chance of having a sun allergy if you have a sibling or parent with a sun allergy;
• also, the presence of atopic dermatitis or another type of dermatitis increases the risk of developing an allergy to the sun;
• Some skin allergy symptoms are triggered when your skin is exposed to a certain substance and then sunlight. Some common substances responsible for this type of reaction include fragrances, disinfectants, bleach, and even some chemicals used in sunscreens;
• those who abuse tanning beds;
• In addition, an allergic reaction from exposure to the sun can also develop in those who the day before performed cosmetic procedures using cadmium salts (tattooing, chemical peeling).

Photosensitizers are the cause of sun allergies

Some vegetables and plants can cause sun sensitivity when they come into contact with the skin. Mango peels, lime juice, parsnips, and celery may cause temporary discoloration (darkening) of the area of ​​skin exposed to the sun. The main phototoxic fruits and vegetables: celery, carrots, rice, parsley, parsnips, and all types of citrus fruits. Therefore, before going to the beach, you should not eat oranges, tangerines or grapefruits. Swelling, redness and itching may occur on the surface of the skin where drops of juice from these fruits remain. And the more active the sun is, the more acute the body’s reaction will be.

Prevention of sun allergies (photodermatitis and photodermatosis)

Unfortunately, there are not many methods for preventing such allergies.

If you have very sensitive skin, make it a rule to sunbathe under a tent or umbrella. Avoid exposure to the sun during peak sun hours (11:00 a.m. to 4:00 p.m.). Protect yourself with a hat and loose clothing made from natural fabrics: linen, cotton. Children have a very weak protective skin reaction, so children under three years old are generally not recommended to be in direct sunlight.

Use sunscreens with high photoprotection from well-known brands, and regularly, at least every two hours. Please note that the cream contains protection against UVB rays (SPF) and UVA rays (PPD) - they are the ones that affect the occurrence of photodermatosis.

It should be noted that wavelength plays an important role. Try not to go to resorts where the sun is especially active.

Recommendations for preventing photoallergy on the beach:

1. Before going to the beach, you should not use cologne, perfume or regular moisturizers. They contain alcohol, which can cause sunburn in the sun.
2. In your case, you need to use sunscreen as often as possible. Just pay attention to its composition. Fat-based products can cause allergies. It is better to choose a hypoallergenic spray with a protective SPF factor.
3. It is better not to use waterproof sunscreen - it clogs the pores, as a result of which ulcers may appear on the skin. When going to the beach, you should opt for a water-soluble product.

If it is not possible to see a doctor, how to relieve acute manifestations of sun allergy?

No way. Only a doctor will be able to understand: the manifestations on the skin relate to phototoxic reactions or are they a manifestation of another disease. Often, “folk” methods only aggravate the course of toxic and allergic reactions.

Classification of photodermatitis

We told you in detail about the main types of photodermatitis. For those who want to delve deeper into this topic, here is a classification of the disease. According to the classification of the famous dermatologist M.A. Steinberg7, photodermatitis is divided into true (photoallergic) and relative. With true photodermatitis, the sun is the leading factor. In turn, this group is divided into congenital (porphyrin bullous skin disease, lightpox, xeroderma pigmentosum) and acquired. The latter include:

• solar eczema;
• pruritus;
• hives;
• cheilitis;
• dishydrosiform dermatitis;
• persistent erythema.

With relative photodermatitis, the sun acts as a catalyst. This group of diseases is divided into the following types:

• medicinal - this includes allergic reactions caused by medications, for example, some antibiotics, as well as dyes;
• professional - meadow dermatitis, toxic melasma, pathologies associated with radiation in production, agricultural work, exposure to petroleum products;
• food - pellagra, pellagroid, light dermatitis associated with quinoa;
• toxic-infectious - lupus erythematosus, solar multimorphic erythema, photomicrobial and photofungal eczema.

The classification of photodermatitis by type of allergic reaction to the sun looks like this4:

• Phototraumatic reactions. Occurs when the skin is overexposed to UV radiation. Expressed in the form of I–II degree burns on open areas of the body. People with white skin, especially albinos, are most susceptible to such reactions.
• Phototoxic reactions. They occur in cases where a person’s body contains substances that increase sensitivity to UV light (photosensitizers). For example, the cause may be porphyrins - substances that accumulate in the blood and tissues.
• Photoallergic reactions. They represent the body's immunological response to an antigen that is formed under the influence of light.
• Idiopathic reactions. These include some cases of skin photosensitivity with unclear causes or little-studied body reactions. An example is solar urticaria.
• Delayed reactions. They are launched some time after chronic exposure to sunlight. These include, for example, actinic (solar) keratosis.

Based on the nature of its course, photodermatitis is divided into two types: acute (photocontact dermatitis, sunburn, solar urticaria, allergies caused by medications) and chronic (polymorphic photodermatosis, pellagra, light pox, porphyria cutanea tarda, actinic reticuloid).

Professional photodermatitis

In dermatology, there is a separate risk factor - “skin of sailors and farmers.” It is professions related to agriculture and the sea that force people to spend a large amount of time in the open sun. This also includes representatives of transport professions - drivers, pilots.

When working in the country, you must not forget about sun protection. Photo: vizland/Depositphotos

Pathology develops most often at the age of 25-30 years7. It manifests itself in the form of redness (erythema) with a bluish tint. Further, pigment spots similar to freckles form in the pathological areas. The skin changes its relief and properties, becoming rougher, thicker, calloused, rougher.

Photodermatitis of summer residents

Summer residents, bathers, people working in the fields are susceptible to phytophotodermatitis (or meadow photodermatitis). It can be triggered by plant pollen deposited on the skin. When exposed to UV light, the body develops a protective reaction in the form of redness and rashes with itching and burning. In addition to pollen, allergies can be caused by volatile oils of citrus fruits, secretions of snails, caterpillars, and mites caught on the skin.

Solar dyshydrosiform dermatitis

This type of photodermatitis, in its symptoms and course, resembles solar eczema. It develops slowly - within 10-20 days. It most often affects people with hyperhidrosis (excessive sweating). Outbreaks occur in late spring and summer when the weather gets hot. The peculiarity of this photodermatitis is the localization of the rashes: on the sides of the fingers, palms and soles. The rash appears first on the arms, then on the legs. The rashes are located symmetrically, as with solar eczema. The rash consists of deep blisters of both small and large sizes. They are covered with a stratum corneum and rarely open. As the disease progresses, the blisters coalesce into spots. Peeling of the skin is typical, and a fungal infection is possible.

People prone to photodermatitis should limit exposure to open sun. Photo/Depositphotos

Sources

1. Bolotnaya L.A. Photodermatoses // Dermatovenereology. Cosmetology. Sexopathology. —2009. — No. 1-2 (12). — pp. 188-197.
2. Princely N. And there are spots from the sun // Asthma and allergies. - 2010. - No. 2. - P. 6-7.
3. Macharadze D.Sh., Tsintsadze N.N. Solar urticaria and other photodermatoses // Medical advice. - 2011. - 5-6. — P. 30-34.
4. Osipova V.V. Photodermatoses: photoallergic reactions // Asthma and allergy. - 2014. - No. 2. - P. 3-5.
5. Polymorphic photodermatosis. Clinical recommendations. - M., 2015. - 15 p.
6. Sidorovich O.I., Tsyvkina E.A. Photodermatoses: prevention and treatment // Medical advice. - 2022. - No. 18. - P. 132-134.
7. Fedotov V.P. Photodermatoses (clinical lecture) // Dermatovenerology. Cosmetology. Sexopathology. - 2015. - No. 3-4. — pp. 143-157.
8. Yarovaya N.F. Photodermatoses // Attending physician. - 2009. - No. 6. - P. 61-66.

Congenital true dermatitis

These are the most difficult clinical cases to diagnose and treat. Often the disease is of an autoimmune nature and is transmitted genetically7. It is often impossible to completely get rid of it.

• Xeroderma pigmentosum. It is characterized by an abnormal skin reaction to sunlight - high photosensitivity. Appears in children in the first year of life. Peak: spring or summer. The symptoms are varied, but most often there is dryness and flaking of the skin, pigment spots, papillomas, wrinkling, and deformation of the skin.
• Light pox. Appears in the second year of a child’s life on the face, hands, forearms, feet, and legs. It begins in the spring and peaks in mid-summer. Exacerbations are possible at any time of the year in bright sunshine. The rash appears as pink spots with blisters that are prone to necrosis. Over time, the spots become covered with a dark red crust. The skin tightens, which can lead to facial disfigurement.
• Porphyrin disease. Characterized by increased skin vulnerability. In spring and summer, under the influence of UV radiation, large blisters with cloudy contents appear on exposed areas of the skin. Then they can flow into erosion and scars. Most often, relapses occur under the influence of the toxic effects of alcohol and petroleum vapors, which cause liver failure. Another risk factor is a lack of B vitamins.

Treatment

Photodermatitis can be successfully treated, but only by eliminating or reducing the effect of photosensitizers1. For this purpose, medications with photoprotective properties are prescribed. In particular, preparations containing nicotinic acid (vitamins PP, B3). It dilates blood vessels, reduces cholesterol levels, improves liver function, and reduces itching. Usually medications are taken orally, but in severe forms they are administered intramuscularly5.

Another effective active ingredient is para-aminobenzoic acid (vitamins B7, H1). On its basis, preparations are made for both internal (tablets) and external (ointments) use.

Allergy to the sun. Photo: JanMika / Depositphotos

The treatment program may also include medications based on the following active ingredients7:

• glucocorticoids;
• thiamine;
• pantothenic acid;
• pyridoxine;
• cyanocobalamin;
• riboflavin;
• resorcinol;
• sodium para-aminosalicylate;
• diphenhydramine;
• calcium chloride;
• benzylpenicillin;
• novocaine

Additionally, allergies can be treated with medications that normalize the functioning of the liver, central nervous system, metabolism, and strengthen the immune system. To get rid of unpleasant symptoms, during the treatment period you need to adhere to a dairy-vegetable diet and give up alcohol. An obligatory part of treatment for almost any photodermatitis is light-protective cream. A doctor should select it.

Important!

• The most dangerous are congenital true photodermatitis. For example, xeroderma pigmentosum on the face leads to disfigurement and the development of cancer.
• Food photodermatitis is characterized by mental damage, which can lead to dementia and depression.
• Occupational photodermatitis threatens the development of chronic skin pathologies, folliculitis, pigmentation, hyperkeratosis, neoplasms, which can degenerate into malignant ones.
• With solar urticaria, the rash may be accompanied by swelling and general disorder of the body, including impaired breathing rhythm and shock.

Solar cheilitis

There are several varieties of this disease with their own characteristics. In particular, eczematous cheilitis resembles classic eczema and appears on the lower lip in the form of blisters against a background of reddened and swollen skin. Over time, the bubbles merge into a single spot, open, and erosions form in their place. At the same time, the skin peels, cracks, and becomes covered with crusts after bursting blisters. The disease can be noticed by thickened, protruding lips7.

Another type is xerotic cheilitis, it develops slowly and lasts a long time. Dry, thin gray scales form along the edges of the lips. They disappear and new ones quickly appear in their place. With a long course, the formation of abrasions and wounds is possible.

Important!

Solar cheilitis is often observed in those who are exposed to UV radiation for a long time and often. This can cause malignancy.

Relative photodermatitis

This group includes photomicrobial and photofungal (mycotic) eczema, as well as solar exudative erythema multiforme. Sunlight activates the body's defense response when bacteria and fungi come into contact with the skin. As a result, pustules (impetigo), crusts (ecthyma), and acne appear.

Scientists (in particular, M.A. Steinberg, V.P. Fedotov7) include lupus erythematosus, a disease of southern countries with a humid climate. The reasons are autoimmune disorders that manifest themselves as persistent rashes. There are acute and subacute forms.

The sun is not an allergen, but can become a catalyst for an allergic reaction. Photo: Wolfness72 / Depositphotos