The Chronic Guide to Summer Skin
Whether you have psoriasis or eczema, rosacea or melasma (or more!), we have expert advice for beating summer flare-ups.
With peak summer in full swing, many folks are rejoicing over the consistently warm weather and the chance to spend more time outside. But for those with chronic skin conditions like psoriasis, eczema, rosacea, melasma, and more, summertime isn’t always what it’s cracked up to be. According to the National Oceanic and Atmospheric Association’s global climate report, the year 2020 is expected to be one of the top five warmest years on record across the globe. Weather forecasters predict that this summer may be hotter than average for most of the contiguous United States–with especially high temperatures in the northeast and across the west.
For those with chronic skin conditions like rosacea or melasma, the sun is a huge trigger for skin inflammation, damage, or redness. While sun exposure in small increments can be beneficial for those with psoriasis and eczema, the super-hot temps and sweat sessions that come with it can elicit some far-from-fun reactions.
“In some patients with skin diseases, the excess heat and sweat experienced in the summer can make the conditions even more uncomfortable and sometimes worse,” says Joshua Zeichner, M.D., the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. “It can also lead to issues like heat rash, dandruff, and folliculitis,” he adds. Additionally, sweating more often can exacerbate some inflammatory skin conditions due to the trace amounts of salt present in perspiration and result in redness, itching, and stinging.
If you have one of these skin conditions and find that you struggle more during the summer, we’re here to tell you you’re not alone—and that there are measures you can take to make these heat waves more bearable, if not enjoyable. We’ve got everything you need to know about sunscreen usage for chronic skin conditions, ingredients that calm inflamed skin, what to do when you think you have heat hives, and much more.
Chronic Skin Conditions and Photosensitivity
When someone’s skin becomes irritated due to sun exposure, whether it be a rash, hives, or some other flare activity, this is known as photosensitivity. It can occur due to certain drugs, such as antibiotics and heart medications — however, some skin conditions themselves cause increased sensitivity to sun. Put it this way: For those with uncompromised skin, a few hours spent basking in the sunshine might mean a golden tan, or, depending on genetics, a bleak sunburn. But for those with certain skin conditions, any extended exposure to the sun can result in uncomfortable and sometimes more serious adverse reactions. If you have any of these skin conditions, you may want to think twice about how you spend your time in the sun.
Polymorphous Light Eruption (PMLE)
Polymorphous Light Eruption (PMLE for short) is thought to be an autoimmune disease in which the skin’s immune system is essentially making a “mistake” and reacting to the sun’s UV rays in the form of a red, non-scaly rash that sticks around for a few days after going outside. P.S. It can itch fiercely, too.
In this case, prevention is the best protection. Load up on mineral-based, broad-spectrum SPFs that contain zinc oxide as these provide protection against the full spectrum of ultraviolet radiation. Additionally, wear clothing that contains Ultraviolet Protection Factor (UPF) when you must be in the sun and avoid the sun during peak hours (10 a.m. and 4 p.m.).
This is a rare condition caused by an allergic reaction to the sun, which results in hives that appear within minutes to an hour of sun exposure — and unlike with PMLE, the irritation usually subsides after a few hours. Currently, the only way to prevent this condition is to practice safe sun protection and to avoid going in the sun during peak hours.
The sun is one of the most common triggers for rosacea flare-ups. It can cause skin redness and flushing (most often on the face) to worsen and rashy bumps to form. For this reason, it’s always best to protect the skin with not only SPF — but with a wide-brimmed hat, too.
Melasma refers to hyperpigmentation or discoloration of the skin and typically takes the form of gray and brown patches on the forehead, cheeks, nose, and upper lip. UV rays trigger melanin production in the skin. Melanin is responsible for the pigment in our skin, so when it’s over-stimulated, hyperpigmentation arises. When outside, be sure to protect your face with a wide-brimmed hat, preferably with UPF protection, in addition to wearing SPF 30 or higher.
Those with eczema may be more prone to burning in the sun if they’re experiencing a flare-up and their skin barrier is compromised. That being said, UV therapy is actually a fairly successful treatment for some folks with eczema as UVB light has anti-inflammatory effects and helps to regulate T-cells and reduce itching. Still, dermatologists advise wearing SPF 30 to protect the skin from aging and cancer.
Similar to eczema, psoriasis is often treated with UV therapy — also known as phototherapy — in a clinical setting. On average, psoriasis tends to improve with exposure to sunlight, though dermatologists recommended limited exposure (ten to fifteen minutes) and always urge patients to wear SPF in order to avoid burning outdoors.
If you’ve ever had any form of hives, then you’re aware that they’re the absolute worst. And well, when they pop up after taking a steaming hot shower or spending time in the sunshine (aka two seemingly blissful activities), they’re even tougher to deal with.
These are known as heat hives or holinergic urticaria, and they’re unique in that they occur when one has an allergic reaction to—you guessed it—the heat. Those with this condition are highly affected by hot temperatures and tend to break out in hives after working out, showering in hot water, or simply sitting outside when the weather is especially boiling. Even eating spicy foods can sometimes cause heat hives as it raises the temperature of the skin. (Such a sick joke, we know.)
Skincare Ingredients and Prescription Drugs that Cause Photosensitivity
Now that you’re up to snuff on the conditions that cause photosensitivity, you need to know about the common skin-care ingredients and prescription drugs that can also make the skin more sensitive and susceptible to adverse reactions from the sun. Below, you’ll find a comprehensive, expert-compiled list. To be clear: We’re not saying you should never use any of these things, but rather be extra cautious about sun protection when you do.
Topical retinoids: These have been shown to cause thinning of the outer skin layer, known as the stratum corneum. A thinner stratum corneum cannot protect the skin as well against UV light, increasing your likelihood of getting a sunburn.
Acne medicines: The main ingredient in many acne medications is retinoid. As mentioned above, retinol or retinoid-containing products are one of the major culprits for photosensitivity. Therefore, be sure to take careful precautions while using acne medications such as Absorica (isotretinoin), Tazorac (tazarotene), and Retin-A (tretinoin).
Salicylic acid: This beta hydroxy acid dissolves connections between cells in the outer skin layer, making the skin more susceptible to sunburn.
Glycolic acid: This alpha hydroxy acid helps the skin shed dead cells from its surface and isolates the outer skin layer, thus increasing your risk of burning.
Essential oils: While many essential oils have soothing, skin-brightening, and anti-aging benefits, some — such as bergamot and lemon — are also photosensitizing. In the presence of UV light, certain essential oils can lead to a phototoxic reaction, which is a chemical burn caused by a reaction between the sun and the essential oil on the skin. If you’re going to use essential oils, you must fully wash them off before going outdoors. And, if they’re in a skincare product that you use, such as moisturizer, be sure to apply SPF liberally and wear a hat if you’re going to be outside for an extended period of time.
Coal tar: This ingredient helps normalize skin cell turnover and helps reduce inflammation of the skin, which is why it is used to treat psoriasis. It is widely available in shampoos as it helps slough away the top layer of dead skin, which, in turn, can make the skin on your scalp more likely to develop a sunburn.
Tetracycline class antibiotics: These are frequently prescribed by dermatologists to treat acne. By lowering levels of acne-causing bacteria on the skin, they can subsequently reduce inflammation and treat pimples. Some of these medications, particularly doxycycline, can put you at risk for a sunburn, though the exact reason is still unknown.
Nonsteroidal anti-inflammatory drugs: Sometimes, the commonly used anti-inflammatory pain-relievers like ibuprofen (Advil or Motrin), or naproxen (Aleve or Naprosyn) are to be blamed for photosensitivity. The way these drugs cause photosensitivity probably has to do with the way they inhibit inflammation elsewhere within your body that inflates your skin’s sensitivity to the harmful effects of the sun.
Heart medications: Certain heart medications like Cordarone (amiodarone), used for heart-rhythm abnormalities as well as blood pressure medications like Cardizem (diltiazem) and Procardia (nifedipine) can trigger photosensitivity. These drugs absorb the UV light and release it into the skin, where it does more damage.
How Does Sunscreen Work?
“Scientific studies support wearing sunscreen on a regular basis to protect against skin cancer,” notes Carrie Kovarik, M.D., dermatology professor at the University of Pennsylvania in Philadelphia. “Sunscreen also prevents sunburn and decreases signs of aging on your skin.” There are two major types of sunscreen that work in different ways:
Chemical sunscreens: These contain ingredients such as avobenzone and octisalate, which absorb UV rays like a sponge. “These sunscreens tend to be easier to rub into your skin without leaving a white residue,” Dr. Kovarik says. Here’s the catch: They can be irritating for sensitive skin because they contain chemical compounds that absorb UV rays ad convert it into energy that’s released as heat. For some, this influx of heat can cause irritation.
Mineral/physical sunscreens: These deflect the sun’s rays off your skin, more like a shield, Dr. Kovarik explains. They contain ingredients like titanium dioxide or zinc oxide. If your skin is super sensitive, this type of sunscreen may be a better bet as they typically contain fewer and gentler ingredients.
The other thing that can be tricky to decode is the Sun Protection Factor (SPF) of your sunscreen of choice. Ideally, dermatologists recommend wearing a minimum of SPF 30 on a daily basis, and that goes for whether you’re going to be indoors, or outdoors. If you’re going to be spending the day outside though, it may be beneficial to shoot for SPF 50 or even 100. The higher SPF doesn't mean it's actually stronger, but it does mean the protection lasts longer.
Speaking of which, if you forget to diligently reapply every two hours, the sunscreen may wear off your skin or be washed away by water or sweat, which will ruin its effectiveness. Another thing to keep in mind is your environment: “Use extra caution near water, snow and sand, as they reflect the damaging rays of the sun, which can increase your chance of sunburn,” Dr. Kovarik says. In those cases, you may also want to use a higher SPF.
In the summer months, the UV index (a standard measurement of the strength of sunburn-producing ultraviolet radiation) is higher on average than during other times of year. Dr. Kovarik explains that the hours between 10 a.m. and 2 p.m. are when the UV index is highest, and when it’s most important to seek shade if you can. Cloud cover also doesn’t indicate an absence of UV rays. “Sun protection should still be used on cloudy days,” Dr. Kovarik says, since thin clouds allow rays through, and puffy clouds can even deflect the rays and increase UV radiation.
Choosing a Sunscreen When You Have a Chronic Skin Condition
Another struggle that many chronic skin folks feel is trying to choose a sunscreen that doesn’t make your skin feel irritated. Psoriasis, eczema, and other skin conditions don’t respond well to many chemicals, and certain products can even exacerbate existing irritation. “For patients that may have sensitive skin, use a sunscreen with the words ‘sensitive skin’ on the label,” Dr. Kovarik suggests. “Avoid products with fragrance, parabens, or oxybenzone: benzophenone-2, benzophenone-3, diosybenzone, mexenone, sulisobenzone, or sulisobenzone sodium.”
Look for physical or mineral sunscreens rather than chemical varieties, as dermatologists say they generally contain less — you guessed it — chemicals and ingredients that can be irritating to sensitive skin types. Dr. Lebwohl tells his patients to buy sunscreen with dimethicone or simethicone, skin-protecting ingredients found in many cosmetic products.
And for the record, don’t try making your own sunscreen at home. “Your own sunscreen has not been tested to be a specific SPF or protect from a broad spectrum of UV radiation,” cautions Dr. Kovarik. “Commercial sunscreens are required to meet strict specifications before claiming to have a certain SPF or be water resistant.”
“Sunscreen should be applied evenly to all the exposed areas of skin, especially your nose, ears, lips, neck, hands, and feet, but be sure to avoid applying sunscreen to damaged or broken areas,” says Michelle Henry, M.D., chair of the education committee of the American Society for Dermatologic Surgery. Here are some to try based on various chronic skin conditions:
For Eczema: EltaMD's UV Clear Facial Sunscreen Broad-Spectrum SPF 46 because it’s formulated with gentle, soothing ingredients like vitamin E, hyaluronic acid, niacinamide, and antioxidants.
For Rosacea: CeraVe Face Lotion SPF 50 because it’s made with skin-calming and texture-smoothing niacinamide, as well as hydrating hyaluronic acid.
For Psoriasis: Sunbum Original Clear Zinc SPF 50 because it features soothing aloe vera and nourishing vitamin E and cocoa seed butter, which can help moisturize dry flaky plaques.
For Hives: Aveeno Protect and Hydrate Face-Moisturizing Sunscreen Lotion SPF 50 because it contains soothing colloidal oatmeal to help calm pesky hives should they appear when you’re in the sun.
Additionally, sun-protective clothing is an excellent option. “People with skin conditions like eczema should wear eczema-friendly clothing (i.e. cotton and other gentle fabrics) with optimal coverage or sun-protective clothing and wide-brimmed hats to avoid sun damage,” says Dr. Henry. “Fabric is rated for its level of protection it provides against the UV rays—a term we call Ultraviolet Protection Factor (UPF).”
The Try-to-Avoid Trend of the Season: “Quarantanning”
Coined by Martha Viera, M.D., a dermatologist at Jackson Health System in Coral Gables, FL, “quarantanning” refers to a rise in sun-related skin conditions as a result of at-home activities like spending more time outdoors or working near a window. “UV rays not only penetrate through clouds, but they can even penetrate through glass and glass windows are mostly designed to protect from UVB rays but not from UVA which penetrate deep in the skin,” says Dr. Viera, who advises wearing sunscreen inside every day. A tip for folks using prescription gels or creams: Wait five minutes to allow the product to sink in completely before applying a liberal layer of sunscreen (preferably mineral as it’s gentler) to the skin. And don’t skimp on reapplying.
Increased Risk of Sunburn and Sun Poisoning
Believe it or not, sunburn and sun poisoning poisoning—which people with chronic skin conditions are at greater risk of getting because of a disrupted skin barrier that makes skin dryer and more irritated—are actually the same.
The only real difference between the two is the level of severity. For instance, when you get a regular burn, you usually experience some redness, soreness, and peeling. In some cases, itchiness, too. But when you get sun poisoning, the symptoms are typically worse. Additionally, you may develop more symptoms, such as small blisters, swelling, nausea, fever, dizziness, and dehydration. To treat sun poisoning, as well as a regular burn, experts recommend taking cool baths to bring down inflammation and applying aloe vera (see below) frequently. If you have a high fever, intense pain, or are vomiting, you should contact your doctor or head to an emergency room, ASAP, to be safe, as you could be experiencing a heatstroke, which can be life threatening.
Skin-Calming Ingredients for Sunburn Relief
Okay, now that we’ve covered a majority of the ingredients and medications that cause sensitivity to sunlight, it’s time to talk about some of the ingredients that help soothe sunburns and skin that’s inflamed (red, itchy, etc.) as a result of the sun and heat. Below, our experts break down which ingredients you should look for and rely on during the sweltering summer months—plus, why they work.
Allantoin: Naturally found in comfrey root, this ingredient is known for its ability to soothe and heal damaged skin and is found in serums, as well as moisturizers. Try: First Aid Beauty's Ultra Repair Cream.
Aloe vera: Probably the most well-known ingredient for soothing skin irritation, aloe is packed with polysaccarides and sterol fats that help generate an antioxidant protein in the skin called metallothionein. These guys go after the sun-induced free radicals, helping to soothe inflammation and redness. Try: Mario Badescu's Aloe Lotion.
Ceramides: These are natural fats found in the outer skin layer. They help the skin retain moisture and protect against environmental aggressors like pollution. Find them in serums, lotions, creams, shower gels, and more. Try: Paula's Choice Ceramide-Enriched Firming Moisturizer.
Colloidal oatmeal: This is both an anti-inflammatory as well as an emollient, a substance that softens and soothes dry, rough, irritated skin by attracting and binding water to your skin’s outermost covering. It also possesses antioxidants known as avenathramides, which actively aid in calming down irritated skin. You can apply it via certain lotions and cream or in the form of a bath soak. Try: Aveeno's Soothing Bath Treatment.
Licorice root: This ingredient helps to soothe red, irritated skin due to the presence of an anti-inflammatory agent called glycyrrhizin. It’s found in many serums, oils, and moisturizers, and is best used by applying it directly to the skin. Try: Eminence Organics Bright Skin Licorice Booster Serum.
Shea butter: This extract is an emollient ingredient that softens rough cells on the surface of the skin and has hydrating benefits that soothe distressed skin. It’s often used to thicken moisturizers and make them blend easier into the skin. Try: La Roche-Posay's Toleriane Ultra Cream.
Soy: This naturally soothing ingredient is ideal for those with rosacea or skin irritations and is found in many moisturizers. Try: Aveeno Positively Radiant Daily Face Soy Moisturizer.
*Additional reporting by Sarah Ellis
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