What Are Causes of Terrible Skin Reactions?

QUESTION: Just when I thought I had gone through a summer without any health
problems, I came down with a terrible skin reaction after but a few minutes in
the sun. My whole body turned flaming red. Can you figure out what caused
this?
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ANSWER: You had a "photosensitive" reaction. That's the simple answer, but
finding out why takes some evaluation by a doctor who is familiar with such
problems.
There are different reasons a person may have a very bad reaction to
sunlight. Several medications cause people to react badly to the sun. Then
there are skin diseases within the body that can cause your skin to burn with
only a small amount of exposure to sunlight. Solar energy in large enough
quantities can burn anybody, but in some individuals absorbed light in any
amount may trigger a photochemical reaction, resulting in tissue damage.
When you speak to a doctor and he or she rules out "normal" overexposure
to the sun (think back, you might have been outside longer than you realized)
it is time to start investigating further. The physician should get a full
history of what medications you are on, did you drink alcoholic beverages
while in the sun or just before exposure, did you wear perfume that could have
triggered an allergic reaction? If there isn't a simple answer to what caused
your severe burn, then it's time to do testing for diseases within the body
that make the skin react.
Lupus Erythematosus is a systemic disease that has been found to affect
about 1 in 800 people in the United States, occurring primarily in women.
Exposure to sunlight is a factor that seems to contribute to the development
or onset of this disease. This chronic inflammatory disease can cause injury
to the skin, joints, kidneys, nervous system and mucous membranes. It is
possible to have flare-up periods and remissions with this disease, and LE
patients are instructed to avoid exposure to sunlight as much as possible to
minimize relapses.
Naturally, it is impossible to avoid sunlight altogether, so it is
imperative that LE patients use a sunscreen daily with a sun protection factor
of at least 15. Patients are also treated with topical corticosteroids and,
in rare cases, with oral hydroxychloroquine.
Dermatomyositis (DM) is another inflammatory disease, characterized by
skin rashes. DM may be complicated by lung disease, esophageal problems,
cardiac conditions and arthritis. Myositis may cause progressive muscle
weakness and tenderness. DM is also associated with an increased risk of
cancer. Lab tests that should be done on DM patients include evaluation of
blood in the stool, mammography and chest films.
Another skin disease, porphyria cutanea tarda (PCT) is associated with
alcohol abuse. PCT patients often show a striking improvement when they stop
drinking. Estrogen therapy in postmenopausal women may also exacerbate this
disease.
If you haven't already been to a doctor about your strange reaction to
the sun, go. As you can see, the skin rash could be a warning sign of a much
greater problem. But if you are like many of my patients (and family), you
probably just underestimated the time you spent sunbathing, and probably took
your exposure when the suns rays where at their highest intensity. Let's hope
so, for then your doctor's visit will be a fine educational visit, and you
will have no serious worries to concern you.