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.
END
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.
Hey man! I know it’s almost 6 years,but what oral steroid did work for you? Thanks!
A short course of prednisolone is the steroid of choice (but only in severe cases).
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.
I’m a Scot with classic blue/freckle-prone skin, but used to be able to be in the sun all day, wearing sunscreen to stop burning. That changed when I was in my early 50s: holiday in Canaries, painful rash on upper arms, chest and thighs from day one, husband thought I would have to go to hospital I was so ill. We’ve avoided hot holidays since but this summer are returning to the Canaries. I’m now 61. In addition to antihistamines, can anyone recommend a particular product that’s worked for them , in similar circumstances to my own ? Thank you!
Nothing useful to add to what I have written above Annie. Sorry.
If you are taking prescribed medicines, this could explain the change.
See here: https://dermnetnz.org/topics/drug-induced-photosensitivity
Hello and thank you! I’m on HRT(Kliofem) but wasn’t when the PLE began. Also take Almotriptan for migraines when necessary. Perhaps using brand names is forbidden, but I’d be interested in particular screens have helped contributers, i.e Miz Spuin, Michy, Posh Rosay…?!? TIA
Hello and thank you! I’m on HRT(Kliofem) but wasn’t when the PLE began. Also take Almotriptan for migraines when necessary. Perhaps using brand names is forbidden, but soundalikes may be useful!? TIA
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.
My sister suffered with it badly growing up and now my little boy gets it badly too. Every year I get caught out at the start of summer when it starts to get hot. As soon as it raises its head and the bumps arrive, I then become fastidious to avoid it continuing. I use Ultrasun spf 30 (expensive) and piritieze , and I can the. avoid it coming back but – If I am not careful or lapse with the ultra sun it’ll be back in a flash.
Hi.
I’ve tried everything and still get prickly heat which covers my arms Chest neck and legs…help the doctor tells me to stay in the shade but if it’s really hot that doesn’t even help
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.
I have suffered from a Skin Problem since March 2021
It was diagnosed as Eczema There are no marks or spots on my skin I am told the condition comes from inside the skin on my legs back and arms
It is like little needles being pushed into my skin It is particularly bad at night I have tried Epimax applying three times daily It gets particularly bad when it is rainy humid and mild
Any suggestions on what it could be or what medication I should use
Thank you
I have suffered with heat rash since being pregnant, I am now 70 and still suffer every time the sun comes out. I will definitely try the above advice as it is so hot at the moment
Anyone tried dettol soap in cleans out your clogged pores it works but you need to scrub every morning and evening
After spending many a summer holiday away, covered in calamine and awake itching all night in my childhood I later found that taking a vitamin E tablet a day, a week or so before going away and while you are out there seemed to cure it in sunny climates.
Doesn’t work so well in the UK as you never know what the weather will be like!!
I have suffered with prickly heat ever since my first holiday abroad years ago. Tried everything but it still appears, It actually starts to make me feel slightly ill. Have now got it at home, maybe because it’s extra hot here at the moment. I am going to try the beta-carotene, anything is worth a try! The last 3 nights I have applied dr.organic maximum strength Aloe Vera Gel to my arms and legs and slept all night without the dreaded itch and scratch cycle. I think it’s because the gel is very cooling on your skin, I use quite a lot of it though! Anti histamine doesn’t work for me.
Found comments interesting so many thanks to those I read…
I was wondering…
I’m a black Caribbean lady from the UK & just returned from a holiday in sunny Tenerife & wore a black one-piece swimming costume where I swam/lay in the sun daily… After a few days the sides of my waist, under & on top of my boobs started itching & hasn’t stopped!!!
Should I have worn a high factor sunscreen even on areas that were covered by my costume?
Like many have said, over the counter antihistamines tablets haven’t worked…
Cold compresses cool the areas & ease the itching, but the itching soon returns & so the cycle goes…
Been home 12hrs where it’s cold & rainy & I’m loving it as although I’m still itching, the cool temperatures mean I get some light relief. But poor hubby’s cold & wants the heating on lol 😆
Inside of my upper arms have started itching…
On reflection I recall all these symptoms the last time we had a ‘heatwave’ here in the UK & I was exposed to the sun where these symptoms occurred in the same areas of my body…
So back to my initial question…
Next time the sun decides to appear or when holidaying in sunny climates, should I wear a high factor sunscreen on covered areas & in addition, which brands do you recommend as high factor lotions leave a noticeable white residue on black skin.
Blessings!
Hello Lyn. If you have dark skin and were wearing a bathing suit I doubt this is UVA related. It could be sweat related but I can only guess from here.
Sorry
Mark
So interesting I found this. I am 65 have never suffered with the sun or rashes from it and suddenly this year have prickly heat rash (itches and stings in mixed amounts day and night!) I get it on my face and hands! I always have factor 50 on my face. I have just tried hydrocortisone 1% cream but has not had any impact. I put cold towels on my face which works to stop the itching etc whilst they are cold but obviously not long term. I have used Aloe Vera which does seem to help but not cure and now trying antihistamine tablets as dr has advised. Fingers crossed. Its exhausting as I dont get sleep. Thank you for all the posts.
I seem to get the rash even when getting out of the shower, or exercising – on my legs/thighs. So I’m sure mine could be sweat rash. Is there a suitable suncream that I can use to not block my pores on holiday?
I have suffered since I was about 18 (never anything when I was a child) but I’ve had it every year since (I’m now 55!). I too have tried many different sunscreens, antihistamine. I know when I have it perfume, insect repellent, deodorant irritates it. I try not to use after sun or body lotion on my skin after my shower in the evening so that my skin has change to breathe. I’m not really sure if it helps or not but my skin feels cleaner. I’ve never heard of taking steroids but it’s a conversation I’ll have with my GP as anything I can do to elevate this condition and make my holidays in the sun more enjoyable is worth a try. Thanks for the advice.
Mine has worsened since menopause. I had it really bad until I started regular Anti histamine tablets but these no longer work. I now have psoriasis, hay fever. Alcohol allergy(beer, wine, spirits ????), acrylates so no more gel nails. Menopause has really made my life hell and no one takes it seriously
Is it possible that you are talking about Polymorphic light eruption instead of Prickly heat rash? From what I can find searching the topic quite extensively now, it seems that prickly heat rash is more often due to blocked sweat glands, whereas Polymorphic light eruption is more likely associated with the reaction to UV rays. It would seem that your assumptions about beta-carotene are accurate according to some research that I found. Nonetheless, i appreciate this article as it seems to have potentially solved my issue with rashes every time I go on vacation. So thank you.
Many cases of “prickly heat” are PLE. That’s the point I tried to make.
Summer rashes are a hot and bothersome reality for many, but with the right tips they can be kept at bay. Thanks for sharing such an informative blog on heat rash.
Having had a break from super hot holidays I had managed to forget about my sun rash, then boom!!! Paros Greece, early June, heat wave!!! Day one itchy raised rash. Having read the above I changed up my sun screen routine to focus on spf and star rating, having only focused on spf previously. Reapplying more often too. This really changed everything, rash didn’t return in spite of continued heatwave for our two week holiday. So, stay out of midday heat, use 5 star products, reapply, bobs your uncle. Thanks Mark.
I always get sun rash every holiday for the last 10 years I’m 42 but this year was determined to tackle this. I bought some good sunscreen from a company called “green people” who specialise in prickly heat/sun rash and have even took beta carotene every day for the last 6 weeks before my holiday. None of it has worked and it just ruins my holiday I swear I’m a walking allergy my only option is professional help like a dermatologist as I can’t even look at going abroad anymore unless it’s in the Antarctic.
I. Get a prickly itchy rash on only my back and front from the neck to the top of my legs . I am 68 yr old women and it started in my late fifties and I only get this itchy rash ax soon as the temperature gets above 28 degrees in the summer . I don’t spend any time outdoors and if I do go out I am always covered up .but I can feel the itching and prickling starting straight away . What is the cause and how is it treated ?
Hard to say from here, but it won’t be PLE. Could be the other type of “prickly heat” (sweat rash) or urticaria. I suggest you take a photo when it is bad and send it in to your GP for a diagnosis.
Mark