Experts say the sun's rays will be more dangerous than
ever this year, with levels of UV radiation expected to
rise over 4%. Not all your patients will heed your warnings
to slap on the suncreen, but what they might not know
is that cancer's not the only thing they need to worry
about. Those piercing rays can cause a slew of skin conditions
that, though innocuous, can leave them worrying more about
what they're exposing when they slip into their
swimsuits. Here are a few tips on what to tell them about
some of those summer skin afflictions.
BEATING
THE BLOTCH
Melasma is a skin condition characterized by
hyperpigmentation patches that usually show up on the
forehead, cheeks and upper lip. The condition is much
more prevalent among women, who make up 90% of cases.
People with darker skin, like Hispanics and Asians,
are also at higher risk.
Sunlight is the single most important
cause of melasma. Pregnancy or other hormonal influences,
like the birth control pill, are also to blame, says
Dr Peter Vignjevic, a dermatologist and professor at
McMaster University. He recommends patients use sunscreen
everyday — rain or shine. You can also write up
a script for hydroquinone cream, which will essentially
bleach the darkened pigment patches. Glycol peels and
microdermabrasion can also help. Tell your patients
that if they don't avoid the sun and use appropriate
protection, treatments won't be as effective and might
not work at all.
OVEREXPOSED
Patients who develop rashes in sun-exposed areas —
anywhere from a few seconds to a few days after sun
exposure — may suffer from photosensitivity,
explains Dr Vignjevic. This increased susceptibility
to sunlight can present in many different ways and can
be caused by a number of underlying factors, including
drugs like diuretics, anti-inflammatories and certain
antibiotics; contact with chemicals or fragrances; autoimmune
diseases and genetic disorders.
A couple of tests can help confirm
your diagnosis. A phototest, which shines different
types of light on the skin, is one option. Photosensitivity
caused by contact with certain chemicals can be confirmed
with a photopatch test, where a light is shined on an
adhesive patch containing photosensitizing materials
that's placed on the skin.
The good news is that even if you
can't figure out what's causing the reaction, you can
do something about it. In the case of solar urticaria
— hives that appear minutes after sun exposure
— tell patients the reaction should resolve on
its own within a few hours. You can also suggest oral
antihistamines to help relieve the itchiness.
Polymorphous light eruptions
are most often crops of small pink or red bumps. "This
rash appears six to 48 hours after sun exposure, usually
on the chest and hands," says Dr Vignjevic. "It usually
starts in the spring and gets better as the summer progresses."
Luckily this condition, which is more common in women,
spares the face. In the case of all types of photosensitivity,
regular use of sunscreen is essential.
HOT,
HOT, HOT
Miliaria, more commonly known as prickly heat,
hits many people during the peak of summer heat. "The
prickly rash is usually observed in areas covered by
tight clothing," says Dr Vignkevic. Tell patients that
antihistamines can help for symptomatic relief. Keeping
the skin cool and avoiding tight clothing is also recommended.
IS
IT CANCER?
Seborrheic warts or skin tags, are the most common
form of benign skin tumours. Skin tags aren't dangerous
and you should reassure patients that they don't lead
to cancer. You can easily remove them in your office.
"Liquid nitrogen is what I prefer," says Dr Vignjevic,
"but you can also use excision or curettage skin tags,
if small. If they're large, you can try scissor removal
with a cautery at the base."
In contrast to skin tags, actinic
keratosis (AK) is an early warning signal of skin
cancer. But early treatment will ensure it never gets
to that stage, so reassure patients that they can be
easily treated, while encouraging them to be extra vigilant.
"The small rough papules are easier to feel than see,"
says Dr Vignjevic. "They usually appear on a background
of sun damaged skin, most often on the scalp, face and
hands." You can easily remove the lesion with liquid
nitrogen. Topical prescription creams like imiquimod
and fluorouracil can protect skin and minimize the appearance
of AK. You should also advise patients to slather on
the sunscreen to prevent any more skin damage.
BARING
IT ALL
Many people are uncomfortable with the awkward appearance
of dry, bumpy, goose-like skin on their upper arms.
This very common benign disorder, keratosis pilaris
(KP) is caused by an excess of keratin around hair follicles
that results in inflammation. Affecting between 50-80%
of teens and 40% of adults, KP tends to be worse in
winter, when the drier conditions increase the inflammation.
Though it's not directly caused by sun exposure, KP
can be a source of embarrassment for patients when bathing
suit season comes a'knocking.
Treatment's pretty simple. Suggest
a lotion with 10% glycolic acid, like Reversa, that
patients can apply two times a day. Also recommend patients
use a loofa when bathing and milder soap, says Dr Vignjevic.
"If that doesn't work, glycolic peels and microdermabrasion
help," he adds. For more severe cases, a weeklong course
of medium-potency topical steroid cream should do the
trick.
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