For every glorious beach or lake day, camping trip, or tromp through the woods, there’s a potential skin problem to go with it: accidental sunburns, unexpected rashes, itchy bites, and more. Here are some of the most common skin hazards – and how to handle them (as always, talk to your doctor if you develop a significant reaction).
Heat rash. Sun and blazing temperatures can cause a variety of pink, itchy, irritated, and generally-unpleasant rashes. Early in the season, sun-exposed areas - such as the face, chest, and forearms - may develop a pink, itchy rash called polymorphous light eruption; this gradually fades as the skin adapts to the summery sunshine, but the rash may appear again the following spring. Later in the season, when it gets really hot, it’s common to see tiny, blister-like bumps called miliaria (if sweat glands become clogged), or a rash within body folds (if the skin stays damp, allowing yeast or other germs to cause redness and irritation). These rashes can sometimes be prevented - if we do our best to keep skin cool and dry, seek the shade, avoid excess UV exposure and peak hours, and practice careful sun protection. Hydrocortisone cream and plain, soothing moisturizers may help to alleviate some rashes. Call your doctor if any skin eruption is severe, not resolving, or if you find yourself relying on cortisone cream for more than a few days.
Sunburn. It can happen to the best of us if we forget to protect ourselves on a hot day, miss a spot, or don’t reapply sunscreen in time. Prevention is always the best treatment, of course, since sunburns aren’t just painful and uncomfortable – they increase the risk of skin cancer and skin aging. That’s why dermatologists recommend wide hats, protective clothing, broad-spectrum sunscreen with at least SPF 30 applied every two hours and after swimming or sweating, seeking the shade, and avoiding the midday sun. Supplements containing nicotinamide (vitamin B3) or the antioxidant fern extract Polypodium leucotomos might make the skin a little more resilient to UV exposure, though they aren’t a replacement for sun protection. Once a sunburn happens, it helps to avoid the sun, stay hydrated, slather on aloe or a rich moisturizing cream twice a day, and consider an anti-inflammatory medicine, such as ibuprofen or aspirin. If fever, nausea, widespread blisters, or body-wide symptoms develop, it’s time to seek medical care.
Breakouts. Sunscreens are important for skin health, but some may worsen acne. Dermatologists recommend protecting blemish-prone skin with a light, oil-free formula labelled non-comedogenic (meaning that it shouldn’t clog pores), such as La Roche-Posay Anthelios Clear Skin Dry Touch Sunscreen with Broad Spectrum SPF 60, CeraVe Ultra-Light Moisturizing Lotion SPF 30, Neutrogena Clear Face Liquid Lotion Sunscreen with Broad-Spectrum SPF 55, or EltaMD UV Clear Broad-Spectrum SPF 46 Moisturizing Facial Sunscreen.
Melasma and sun spots. The strong ultraviolet light during summer can quickly and dramatically darken melasma (discolored patches of skin on the cheeks, upper lip, forehead, or jawline) and sun spots (what docs call solar lentigines - basically adult freckles). That’s why a broad-spectrum sunscreen with a high SPF (at least 30, and ideally 50 or higher) is critical. Your dermatologist can offer prescription treatments that may help these spots or patches resolve faster; they might include hydroquinone cream, retinoids, chemical peels, or laser or light treatments.
Rashes after swimming. Chlorine can dry or irritate skin, making moisturizer important during the summer months. And after a dip in the lake, river, or ocean, we might notice other reactions: swimmer’s itch (itchy pink spots caused by an allergy to tiny organisms called shistosomes), seabather’s eruption (bumps that form under the swim suit, caused by a skin reaction to the thimble jellyfish, unguiculata, which is found in the Atlantic and the Carribbean), jellyfish stings (they often appear as welts on the skin that can be itchy, swollen or tender), or a potentially-serious infection called Vibrio vulnificus - an ocean bacterium that could lead to skin sores, blisters, and possibly, a dangerous bloodstream infection. It can be hard to prevent or predict these problems, but it may help to rinse with fresh water after a dip in any body of water. Many reactions run their course in a week or two, but call your doctor if you develop a severe or painful rash, open sores, fever, or other significant symptoms.
Bug bites. No one’s immune to them, but that one person who winds up with dozens might have a condition called papular urticaria - an allergic reaction to bites. Bug sprays containing DEET or picaridin may help to prevent them, along with protective clothing. Once a bite has happened, hydrocortisone cream may help to reduce swelling and itching (cortisone creams aren’t intended for prolonged use), along with antihistamine medicines (such as over-the-counter loratidine, cetirizine, fexofenadine, or diphenhydramine), ice packs, cool towels, or a chilled lotion. Call your doctor if you ever have a spot that won't heal, drains, bleeds, or seems infected.
Poison oak or ivy. Few substances in the world can cause such maddeningly itchy rashes as the poison oak and poison ivyplants. Their leaves, stem, and roots contain a natural oil called urushiol that can deposit on the skin, causing redness, rash, and even blisters that may persist for 3 to 4 weeks. The oil is washed away with soap and water, so it can’t be spread around or passed to others once we’ve bathed - but we could pick it up from clothing or a dog that’s collected urushiol on its fur. Recognize and avoid the plants (as an old saying goes, if you see “leaves of three, let them be”), cover areas of skin that may be exposed if you’re going to be in the woods, toss clothes directly into the laundry afterward, and wash skin thoroughly with soap and water if you suspect you’ve made contact. Calamine lotion and oatmeal baths may help relieve itch, and a doctor can prescribe cortisone creams or pills if needed - like if rashes are intense or widespread, if you have a lot of facial swelling, or if you’re not able to sleep due to itching.
Tick bites. The warmer months are peak season for hungry ticks, which lurk in grassy, wooded areas waiting to cling to unsuspecting hikers, campers, and gardeners. A tick bite often doesn’t feel like anything (I’ve plucked two off of unsuspecting patients already this summer), so check your skin for critters if you’ve been out in the woods or gardening. If you find one, cleanse the site with rubbing alcohol and use tweezers to firmly pull the tick out, or call your doctor for help. It’s thought that a tick has to be on the skin for 24 hours or more to be able to spread disease, such as Lyme or Rocky Mountain Spotted Fever. It’s important to call your doctor if you develop redness, rash, fever, aches and pains, or other symptoms after a tick bite.
Margarita dermatitis. Consider it the most delicious of all skin rashes: Sun exposure combined with a splash of lime, lemon, or other botanicals can lead to a discolored patch, often on the hands or forearms, occasionally with blisters or itching. Called phytophotodermatitis, this unharmful condition usually resolves within two to three weeks, though the dark marks left behind could linger for longer.
BY LAUREL NAVERSEN GERAGHTY, MD