Courtesy of The Times:
Summer is coming and with it a scourge of my youth that has blighted many a holiday abroad. Indeed during the hottest summers (1976 was particularly bad) I even developed prickly heat at home. I am far from alone — as many as one in five people in the UK suffer from the sun-induced skin rash at some stage. So what is the best way to tackle it?
Prickly heat is an old-fashioned name for any itchy rash that develops in hot, humid or sunny conditions, such as those most of the UK is experiencing today. Herein lies the problem. The term is used to describe everything from sweat rash to an allergy to sunscreen, which goes a long way to explaining why so few victims find an effective remedy. What works for sweat rash won’t help allergies, and vice versa.
In practice, most cases of prickly heat have nothing to do with heat, sweat or allergies, but are caused by sensitivity to the UVA portion of sunlight — the highly penetrative fraction that can travel through clouds, glass, water and even some thin clothing. Doctors call it polymorphic light eruption (PLE) and the sensitivity is more common in women and typically first appears during childhood or early adulthood.
The classic symptoms of PLE include an itchy, red rash that develops two to three days into your holiday (or during a sunny spell at home). It is normally symmetrical, with commonly affected sites including the chest, tops of the feet and upper arms. It is unusual to develop it on areas more used to the sun, such as the face and backs of the hands.
The key to preventing prickly heat is to reduce exposure to UVA by using a decent sunscreen. These are rated in two ways. The sun protection factor (SPF) is a measure of how much protection they give against sunburn-causing UVB, while the star rating is a measure of the ability to block UVA rays, which cause prickly heat. If you are a regular sufferer go for a minimum SPF 20 (30 o more is better) and five stars, and reapply every two hours (UVA filters break down quickly).
Using the wrong type of lotion will make matters worse. We can all feel UVB-induced sunburn but have no idea what sort of dose of UVA our skin has received. So a high-SPF, low-UVA star-rated lotion (as most older lotions were) just encourages you to spend longer in the sun and makes matters worse — which is why so many prickly heat sufferers mistakenly believe they have an “allergy” to sunscreen.
UVA is highly penetrative so use the sunscreen even on cloudy days and in the pool, and try to avoid direct sunlight between 11am and 3pm when strength of UVA radiation is up to ten times higher than earlier in the morning or later in the afternoon.
Some dermatologists advocate beta-carotene supplements because they are thought to boost the skin’s natural defences to UVA (although the science is shaky); 10-15mg daily from a week before flying until the end of your holiday is a typical recommendation.
Last, avoid using a sunbed to give you a base tan before you go. Most sunbeds deliver much higher doses of UVA than natural sunlight and while a prolonged course can help to prevent prickly heat by desensitising your skin, a few sessions will have the opposite effect and make an attack more likely.
After more than 20 years of suffering I haven’t had an episode of prickly heat since following this regimen and it has worked for a lot of my friends and relatives. But PLE tends to settle with age and mine may have resolved spontaneously, so I am keen to hear your experiences if you give it a try this summer.
If you do develop prickly heat:
■ Avoid any sunlight on the affected area for at least 72 hours — and that includes sitting under a shade on a beach where reflected UV rays can still reach you. Cover up.
■ Antihistamine tablets are said to help but they never worked for me; the best bet is to apply a topical steroid cream twice daily to the itchy area. It will take 24 hours to have any effect, so persevere. You can buy 1% hydrocortisone cream over the counter, but stronger prescription-only creams are likely to work better.
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This is so interesting and the only place I have seen anyone else referring to PLE. I was diagnosed by a skin specialist when I was pregnant with my twins and since then have been prescribed low dose steroid tables for holidays and they have literally changed my whole experience with sunny climates. I don’t have any heat rash and 8 years later am managing to go on holiday without medication at all. I put this down to the fact that I regularly drink kefir or that my skin has been desensitised but had not considered that age might also be a factor (am now 40). We are moving to Queensland Australia this year and am nervous about the heat and humidity bringing back my heat rash days but I guess only time will tell. I will definitely be trying the beta carotene supplements. Wish me luck!
This is great advice as all I have had as advice previously has been to shower after pool and at end of day following sunscreen. I insisted the rash was neither sweat related, clogged pore related or chlorine related as it was only in areas exposed to the sun. I had suspected UV reaction or sunscreen reaction and tried every sunscreen under the sun. The only issue is as I can’t get a GP to take this seriously how will I get oral steroids prescribed before any holidays. I already take antihistamines to no avail, currently suffering having just got back from cloudy holiday in Cyprus spent considerably in shade. Also no chance of referral to dermatologist in current state of nhs, have just asked! Also for me it’s just got worse with age.
This is a new take on my prickly heat that I’ve suspected previously but only recently came across this article relating it to UVA. Nothing topical works for me, only oral steroids. I’ve just learned to live with when it comes out, but this last trip to Kauai has gotten me dying now at home. Will try the daily sunscreen and see if it helps with future outbreaks. Tried virtually everything under the sun…get it? hahah. Seems areas that are typically covered by clothing don’t get the rash. My feet, calves, forearms and arms up to my sleeves usually get it. It’s so weird. Dermo says it’s not a skin issue, it’s a scratching issue (if I don’t scratch then none of the bumps would get bad..horrible diagnosis) and allergist said it’s not allergies either.
I didn’t suffer from prickly heat until 3 years ago when we went on holiday to Greece where it was very hot , and every holiday abroad since then I have had it, this year I took antihistamines which helped with the itching but didn’t prevent it, I bought a sunscreen last year which was recommended to stop prickly heat but I still had it, this year I didn’t use ant sunscreen at all and tried to stay in the shade where possible and I still had prickly heat, its ruining my holidays, i might try the beta carotene next year because I really don’t know what to do to stop it anymore.
Steroids are another option but very strong and generally only used once a dermatologist has confirmed the diagnosis of PLE. Desensitisation using medical UK therapy another option – once again under dermatologist.
It’s good to see a proper discussion about prickly heat and it’s likely causes, as everywhere just says the usual stay in the shade, shower, stuff and it has never helped me. I barely went out in the sun on my holiday to Cyprus and still got covered all over my stomach, legs and arms. I walked to the vet in the U.K. yesterday and thought nothing of it because the weather is just warm and I’m now covered in a rash. It really makes my life difficult and nothing I’ve ever tried has worked to prevent it. It’s good to know about the star rating of suncream and I will try that.
Mine started in my 30s, its less so since I hit the menopause. I was advised to use non waterproof sunscreen as waterproof would stop the skin sweating. No idea if that’s true but was prepared to give it a go and it did seem to work. Nothing except COVID19 is stopping me spending time worshipping the golden ball in the Mediterranean sky.