Beware of Sunburn Boosters

Some medicines and skin care products can increase your sensitivity to the sun. Here’s how to avoid getting burned.

From the WebMD Archives

You take care of your skin, making sure to use sunscreen, a cleansing routine, and moisturizer.

Yet there’s one simple step you may have overlooked that is just as important: Checking out the medicine cabinet and pantry for products that may raise your risk of sun sensitivity.

Prescription drugs, over-the-counter pain relievers, herbal remedies such as St. John’s wort, perfumes, exfoliating skin care products, and even some sunscreens can increase sensitivity to the sun. And some foods may boost it, too. Contact with a lime peel can produce an intense burn, so watch out for those poolside margaritas and vodka tonics.

Pain aside, a bad sunburn or excessive sun exposure increases the risk of skin cancer. So does sun sensitivity, a condition most often associated with having a fair complexion.

Excessive sun can also age skin prematurely, causing wrinkles and brown spots.

Sun Sensitivity: What It Is

Sensitivity to the sun, also called photosensitivity, is a reaction set off by the sun’s ultraviolet rays. One type is a phototoxic reaction, which occurs when UV radiation reacts with a drug to form compounds that damage the skin. Sunburn-like symptoms show up within a few minutes or as long as several hours after exposure, on sun-exposed skin only.

Less common are photoallergic reactions, which usually happen when UV light changes a substance applied to the skin, causing an immune response. Bumps, hives, blisters, or red blotches may appear as soon as 20 seconds after getting out in the sun, but more often show up from one to three days later. Skin irritation most often occurs on exposed areas but can spread to other areas.

The reaction depends on the individual, the substance, the amount taken, and the amount of UV exposure. People with light skin, already considered the most sun-sensitive, are more susceptible to phototoxic reactions. The melanin in darker skins is believed to offer some protection. Those with compromised immune systems, such as people with HIV/AIDS, may also be more prone to sun sensitivity.

The effects can wear off quickly if they’re caused by physically or chemically removing the outer layer of skin (through products like oatmeal scrubs or chemical peels), says Barbara R. Reed, MD, a clinical professor of dermatology at the University of Colorado Hospital in Denver. But the effects may worsen over time if they’re caused by an allergy.

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“Gently exfoliating your skin is unlikely to make you so sensitive that you can’t tolerate outdoor sports, but Accutane and other drugs certainly can,” says Rachel Herschenfeld, MD, a Wellesley, Mass., dermatologist.

Drugs that cause phototoxic reactions can increase sun sensitivity at higher doses, Herschenfeld says. The drug doxycycline, for example, can be given in low doses of about 40 milligrams daily to treat acne, or in higher doses of 100-200 milligrams daily. Those who take the lower dose at night will see blood levels of the drug peak at night, when they are not at risk of sun exposure, she says. That reduces their risk of photosensitivity.

How do you know if you’re more sensitive to the sun? Signs include burning more easily than in the past or noticing rashes, bumps, itching or changes in pigmentation after exposure to sunlight.

“If you’re just getting out for a brief time and notice some burning or stinging on your skin, you should be suspicious,” says Roger Ceilley, MD, a clinical professor of dermatology at the University of Iowa.

If you notice symptoms that concern you, check medicine labels and check in with your physician. Doctors may diagnose sun sensitivity based on the skin’s appearance and exposure to substances that trigger photosensitivity. Occasionally they may perform a patch test to confirm a photoallergic reaction.

Sun Sensitivity: Common Culprits

To find out if you’re taking a drug that increases sun sensitivity, read the information sheet that comes with medications, advises Dennis Bryan of Chicago, a media adviser for the American Pharmacists Association. Ask your doctor or pharmacist whether any medication you’re taking might cause sun sensitivity.

Here is a list of common drugs, foods, perfumes, and skin care products linked to varying degrees of sun sensitivity.

Acne treatments: Creams and astringents with benzoyl peroxide. Prescription drugs including Accutane, doxycycline (an antibiotic), and Soriatane.

Antihistamines: Benadryl and other products with diphenhydramine.

Antibiotics: Tetracyclines, including Sumycin, Tetracyn, and Vibramycin (doxycycline). Sulfa drugs including Bactrim and Septra. Quinolones, including Cipro and Levaquin.

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Antifungals: Griseofulvin, including Grifulvin V, Fulvicin P/G, and Gris-PEG.

Anti-inflammatories: Prescription and over-the-counter nonsteroidal anti-inflammatory pain relievers, including Celebrex, naproxen (Aleve), and ibuprofen (Motrin, Advil).

Chemotherapy drugs: Imatinib and dasatinib.

Cosmetic treatments: Microdermabrasion, chemical peels, laser treatments, exfoliating facial scrubs.

Diabetes: Sulfonylureas including Diabinese (chlorpropamide) and glyburide (Micronase, DiaBeta, Glynase).

Diuretics: Hydrochlorothiazide (HCTZ), used to treat high blood pressure. Lasix (furosemide). Combination drugs with HCTZ include Dyazide, Hyzaar, Maxide and Zestoretic.

Foods: Celery, citrus fruits (such as lime peel), dill, fennel, parsley, parsnips, and artificial sweeteners.

Heart medicines: Amiodarone (Cordarone), nifedipine (Procardia), quinidine (Quinaglute and Quinidex), and diltiazem (Cardize, Dilacor, and Tiazac).

Herbal remedies: Dong quai, St. John’s wort.

Perfumes: Lavendar, cedar, bergamot oil, sandalwood, rose bengal, musk, 6-methylcoumarine.

Psychiatric: Tricyclic antidepressants such as Norpramin and Tofranil; the antipsychotic medication chlorpromazine (Thorazine).

Skin care products: Check ingredients for alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), salicyclic acid, glycolic acids, Retin-A, and hydrocortisone.

Sunscreen: Benzophenones, dibenzoylmethane, oxybenzone, cyclohexanol, salicylates, cinnamate, and PABA (para-aminobenzoic acid).

Sun Sensitivity: Protecting Your Skin

If you are sensitive to the sun, the best way to protect your skin is to avoid exposure, dermatologists say. That means no tanning booths and no lying out at the beach, even with sunscreen.

If it’s not possible to avoid sun exposure, use sunscreen with an SPF of at least 15; choose a higher sun protection factor of 30 or more if you have a fair complexion or are more sun-sensitive. Make sure to apply at least 1 ounce for adequate coverage, put it on at least 20 to 30 minutes before going outdoors, and reapply every two hours or after swimming or perspiring heavily. Keep in mind that some damaging ultraviolet rays can penetrate window glass, which means you could get a sunburn while driving or inside, if in direct sunlight.

Not sure which sunscreen to buy? The American Academy of Dermatology recommends choosing one that offers broad-spectrum protection against UVA and UVB rays. A sunscreen’s SPF rating measures effectiveness against UVB rays, which damage the outer layer of skin and cause sunburns. UVA rays penetrate the middle layer of your skin, and are the most likely to trigger drug-induced sun sensitivity reactions, says Herschenfeld.

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Check the ingredient list for good UV covereage. The American Academy of Dermatology recommends to look for ingredients such as ecamsule (Mexoryl SX), titanium dioxide, zinc oxide, and avobenzone.

Beyond sunscreen, dermatologists offer these suggestions for avoiding sun damage: Stay out of the sun between 10 a.m. and 4 p.m., when ultraviolet rays are strongest; wear a wide-brimmed hat and sunglasses; wear long-sleeved shirts and pants; and stay in the shade.

If you have a reaction, treatment usually consists of cool compresses and corticosteroids applied to the skin. Your doctor may advise you to avoid the sun or an irritating substance that caused the reaction, such as lime peel; make changes in your medication; or, in severe cases, prescribe corticosteroids.

WebMD Feature Reviewed by Louise Chang, MD on May 19, 2009

Sources

SOURCES:

American Cancer Society: “Cancer Facts & Figures 2008.”

American Academy of Dermatology: “The Sun & Your Skin.”

FDA: “Chemical Photosensitivity: Another Reason to be Careful in the Sun.”

eMedicine: “Drug-Induced Photosensitivity.”

Vassileva, S., Archives of Internal Medicine, October 12, 1998; vol 158: pp 1993-2000.

Rachel Herschenfeld, MD, Dermatology Partners Inc., Wellesley, Mass.

Roger I. Ceilley, MD, clinical professor of dermatology, University of Iowa.

MedicineNet.com: “Sun-Sensitive Drugs.”

Barbara R. Reed, MD, clinical professor, department of dermatology, University of Colorado Hospital, Denver.

Dennis Bryan, media adviser, American Pharmacists Association.

FDA: “UV Radiation.”

FDA: “Beta Hydroxy Acids in Cosmetics.”

© 2006 WebMD, Inc. All rights reserved.

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