Do you get itchy, swollen, red rashes when you’re outside?

You may
have a case of 'sun allergy'
It is known as solar urticaria and while rare, it may be easily confused
with heat rash. Dermatologists explain what the skin condition is.

It is not sunburn but an allergy to UV rays. (Photo:

iStock/Doucefleur)

Khoo Bee Khim

14 Sep 2022 07:00AM(Updated: 14 Sep 2022 07:00AM)
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So, there you are, exploring one of the island’s green corridors,
chilling on the beach, or maybe just doing a quick coffee run in the
afternoon sun – and your skin starts to develop wheals or swollen, red
rashes.
It’s just a slight sunburn, you think, although the textured patches are
uncharacteristic of too much UV exposure. But soon, they begin to
sting, itch and burn. What is going on?
It could be solar urticaria or what is known as sun allergy.
Occasionally, the wheals can blister and become crusty, said Dr
Eileen Tan, a dermatologist at Eileen Tan Skin Clinic & Associates.
“They usually appear within minutes of sun exposure,” she said,
adding that the disease usually manifests in those in their mid-30s and
is more prominent among females.
The term “urticaria” refers to the hives or itchy, raised red areas on
the skin caused by a reaction to certain foods, drugs, infections, stress
– and in the situation of solar urticaria, UV rays.
Solar urticaria is rare, according to Dr Eugene Tan, a senior
consultant at the National Skin Centre. “It is estimated to comprise
approximately 0.5 per cent of all cases of urticaria. On average, I see
one patient with solar urticaria every two months.” Dr Eileen Tan
agrees. “In my experience, solar urticaria is uncommon. I see maybe
three to five cases per year.”
Hives or swollen, red rashes that itch, sting or burn are characteristics
of solar urticaria. (Photo: iStock/Black Lollipop)
Still, there is a chance you might have solar urticaria if you tend to
break out in the sun. You might have just ignored those episodes as
they typically resolve “within a few hours when sun exposure is
avoided”, said Dr Eugene Tan.
There’s also the possible likelihood that the hives are a reaction to
Singapore’s infernal heat. When, then, do you break out the prickly
heat powder or see a dermatologist for a sun allergy? Here’s what the
dermatologists say.
HOW DO YOU TELL IF IT’S SOLAR URTICARIA OR HEAT
RASH?
One key distinction is, solar urticaria tends to occur on sun-exposed
areas within a few minutes and even up to 30 minutes of sun
exposure.
“It depends on the individual level of sensitivity to sunlight and the
time of the day in which sunlight exposure occurs,” said Dr Eugene
Tan. “Since the mid-day sun (between 10am and 4pm) is more
intense, it will take a relatively shorter time of exposure to induce
urticaria in the early morning or evening sun than when exposed to
the mid-day sun.”
Unlike heat rashes that tend to occur where sweat accumulates such
as on the back, solar urticaria is likely to appear on sun-exposed areas.
(Photo: iStock/RyanKing999)
On the other hand, heat urticaria or heat rash is likely to appear in
areas where sweat tends to accumulate such as the back, bra line and
armpits – and is the result of temporarily blocked sweat glands, she
added.
While both can cause itchiness, their physical appearances are
different. Heat rash resembles small, inflamed blister-like bumps that
can occasionally be filled with pus, said Dr Eileen Tan.
Moreover, heat urticaria can develop in a hot environment with or
without sunlight; for example, taking a hot bath or being in a sauna,
said Dr Eugene Tan.
WHY DOES THE SKIN OF SOME INDIVIDUALS REACT THIS
WAY TO THE SUN?
The exact cause of solar urticaria is not known, said Dr Eugene Tan.
“One hypothesis is that some individuals have a precursor molecule in
their skin that is converted to a photoallergen or sun allergen when
exposed to a specific wavelength of light,” he explained.
When the immune system detects these photoallergens, it mistakes
them as dangerous invaders and sends out antibodies, in this case
immunoglobulin-E or IgE, to bind to the photoallergens. This then
triggers urticaria, said Dr Eugene Tan.
(Photo: iStock/PraewBlackWhile)
As for the radiation spectrum that causes solar urticaria, it varies from
patient to patient, said Dr Eileen Tan. It can range from invisible
ultraviolet B (or UVB) to visible light, or from 300 nanometers to 500
nanometers. For this reason, you could potentially develop solar
urticaria even when indoors if you work next to an exposed window,
said Dr Eugene Tan.
Some medications can also trigger the disease, added Dr Eileen Tan,
including atorvastatin (statin medication for cardiovascular disease),
chlorpromazine (antipsychotic medication), tetracycline (oral
antibiotic) and oral contraceptives.
WHAT TREATMENTS ARE THERE?
Sun protection is key to healthy skin but it is even more important if
you suffer from solar urticaria, say both dermatologists. “Patients are
often able to avoid precipitating their urticaria because from
experience, they know the amount of sun exposure that is needed to
trigger their hives,” said Dr Eugene Tan.
Other than the use of a broad-spectrum sunblock, clothes and
accessories that offer UV protection, the first line of medication is
antihistamines. They can be taken around the clock for the first few
days of a flare-up for symptom relief, said Dr Eileen Tan. “If needed,
patients can take antihistamines 30 minutes before they go outdoors,”
said Dr Eugene Tan.
Oral corticosteroids are rarely used for solar urticaria. (Photo:
iStock/Alyona-Kos)
Unlike eczema or other forms of skin allergy, oral corticosteroids are
“rarely used” for solar urticaria, said Dr Eugene Tan, unless it is “a
severe flare of acute urticaria”.
Other treatments that may be considered include injections of
monoclonal antibodies that bind to and block IgE (omalizumab), oral
immunosuppressant (ciclosporin or cyclosporine) and plasma
exchange therapy.
WHAT PRECAUTIONS CAN PATIENTS TAKE TO MINIMISE
FLARE-UPS?
According to Dr Eugene Tan, oral polypodium leucotomos (a fern
extract) has been shown to confer UV-protective effects in patients
with sun-sensitive skin disorders. A photo test may also be useful to
patients to determine the provoking wavelength, he said. “For
example, patients who are sensitive to UVA should look for broad-
spectrum sunscreens with high UVA protection factor instead of only
focusing on the SPF rating because SPF is a UVB protection factor,”
he said.
In some cases, phototherapy to desensitise skin to UV rays may be
used. (Photo: iStock/puhhha)
In some cases, phototherapy to desensitise skin to UV rays may be
used. “The gradual UV dose increment and increased tanning of the
skin over time help to ‘harden’ the skin such that the patient will be
able to tolerate a longer duration of sun exposure before urticaria is
triggered,” said Dr Eugene Tan. “This can be achieved after two to
three months of twice-weekly phototherapy.”
However, there are caveats to this method. “Phototherapy is more
useful for patients living in temperate regions with seasonal climates,”
he said. Added Dr Eileen Tan: “Phototherapy is often not a popular
option as frequent, multiple visits are not feasible and convenient for
working individuals”.
Source: CNA/bk
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