Summer and Rheumatoid Arthritis: Photosensitivity

Patient Expert

Summer is finally here, and I for one couldn't be happier about it. Bring on the hot days, the soaking thunderstorms that strike out of nowhere, and even the humidity; after a long, cold, snowy winter, both my spirit and my joints are ready to shed some layers and enjoy the heat. I know to some, 90 degree days sound awful, but I much prefer the misery of being hot and sweaty to the misery of being bitterly cold and brittle. I didn't grow up in the South and at the beach for nothing.

Unfortunately, as much as I love basking in the sun's rays, my skin does not. To describe me as fair-skinned is an understatement. I am pale, pale, pale. I'm so pale, I practically emit light when I go to the beach and lay out in my bikini. I used to be self-conscious about my fair skin when I was younger and having a deep, brown tan was considered stylish, but as I got older, I got over it and accepted that I will always be pale.

It probably goes without saying that I burn quite easily. It doesn't take more than a few minutes of exposure before my skin begins to turn pink. I suffered a few bad sunburns as a child when I forgot to put on SPF and remember spending hot nights with the sheets thrown off, aloe vera all over my skin and the fan blowing directly on me until I fell asleep, my skin hot to the touch.

So I was not thrilled when I found out that one of the medications I take for rheumatoid arthritis was going to make me even more prone and sensitive to sun exposure. One of plaquenil's side effects is photosensitivity. Part of me thought it wasn't possible for me to be even more sensitive to the sun than I already am, but I was wrong. I can get a touch of sunburn from walking around outside to run errands or on my way to work. Incidental sun exposure may seem like no big deal, but for me, it is.

And if that's not enough, I also take a TNF inhibitor to manage my RA, and TNF inhibitors have been shown in some studies to lead to a slightly higher incidence of skin cancer- not high enough to outweigh the benefits of the medication against rheumatoid arthritis, but vigilance is necessary. I see a dermatologist once a year to get a full body scan and make sure nothing creepy is growing on my skin.

The upside to this side effect is that overexposure to the sun is mostly preventable-perhaps not completely unless you are planning to become a hermit, but there are many actions we can take to protect our skin from the harmful UVA and UVB rays of the sun.

For starters, avoid going out for prolonged exposure during the hottest parts of the day when the sun is at its peak. I haven't given up going to the beach, but I tend to go earlier in the morning or later in the afternoon when the sun isn't as strong. While SPF 15 is typically recommended for most people, you may want to go with a higher SPF and make sure it protects against both UVA and UVB. I have been guilty of falling into the 'higher is better' trap- as much as SPF 75 when I'm going out for a day at the beach; however, most research shows that there is not much added protection, if any, above SPF 50, so be sure to talk to a dermatologist to find out exactly what SPF you should be using. Although it takes more planning and time, I slather up at least 30 minutes before I head out to make sure my skin won't be at risk. I also wear a hat for extra protection for my face and bring a cover up so that I can, well, cover up if I feel I'm getting too much sun. Umbrellas are another great way to make sure you can enjoy the beach without getting burned.  If I step out for a swim in the ocean, as soon as I dry off, I reapply my SPF generously even if it says it's waterproof- terms like 'waterproof' and 'sweatproof' are just marketing lingo, so don't be fooled. I also reapply about once every hour or so- better safe than sorry.

It's important to protect your skin even when you aren't at the beach or outside for long periods of time. I wear sunscreen everyday. Many moisturizers contain SPF, but if you are relying on this for your sun protection, beware: in order to get proper protection, you need to put on quite a bit of SPF moisturizer. A better option is a lightweight sunscreen that can be worn under make-up. There are a lot of great products out there these days that aren't greasy or gross. Keep in mind that it's important to protect more than your face- don't forget your neck, chest and arms, and any other parts that are going to be exposed.

The classic song lyrics may claim its 'Summertime, and the livin' is easy,' but if you are livin' with RA and it's sunny outside, then you have work to do before you can kick back with an ice cold drink in the sun. Like every other aspect of life with RA, making sure we protect our skin, particularly if we are on medications that increase our risk of sunburn and skin cancer, is really just a matter of planning and preparation. But if it means my skin stays healthy and I have one less issue to worry about, it's worth itFor more information about skin cancer, check out HealthCentral's Skin Cancer Connection.

On June 14, 2011, the Federal Drug Administration revised their guidelines for SPF. They have provided a Q & A page  on their website to help consumers understand them.  Check them out here and consult your doctor with any questions you may have.

Sara is the author of the blog, The Single Gal's Guide to Rheumatoid Arthritis.