Consultant dermatologist Sue Aquilina shares a few tips on how to combat some of the commonest summer skin issues with Sandra Aquilina.
Sunburn
While most of us are aware of the dangers of sunburn, on overcast or cloudy days you might be fooled into thinking that you do not need to be careful.
But light cloud cover provides no protection from the sun’s harmful UV rays.
Always check the UV index. Windy days, too, may keep you feeling cool and fresh, but will do nothing against the UV rays.
Keep to the shade, cover up with clothing and a suitable hat, and wear sunscreen over exposed skin.
Be sure to reapply sunscreen if it got wiped off with a towel, if you were swimming for a while, or if you sweated heavily.
Modern sunscreens vary from a moisturising creamy texture (that may also be tinted) for everyday use on the face of people with a tendency to dry skin, to an ultra light, anti-shine texture especially suited for outdoor workers who may be sweating heavily.
Sprays are very popular for large areas, especially for children, but should not be sprayed directly on the face (spray into your hands first).
Don’t forget to get an appropriately high SPF with good cover against UVB and UVA, and to apply quite thickly without missing any areas (don’t forget your ears). Balding men should wear a hat or sunscreen as much as possible. Their scalp will be especially prone to accumulate sun damage over their lifetime, especially if they started losing their hair at a young age.
Pigmentation and sun spots
Accumulated damage from the sun’s harmful ultraviolet (UV) rays mainly that from UVA, is responsible for skin photo aging, i.e. brown spots, broken blood vessels in the skin, wrinkling, dryness and destruction of the skin’s collagen and elastic fibres.
Prevention is paramount here, as reversal of these processes is not at all easy.
Sun damage accumulates over a lifetime, and especially affects people with fair or sun-sensitive skin.
One should keep in mind some differences between the mainly photo aging and tanning UVA and the mainly sun burning UVB. UVA starts building up very early as the sun rises and persists with relatively equal intensity until the sun sets, so it does not show the marked peak around noon that we see with UVB.
So sunrise and sunset joggers should still be careful! UVA also has a longer wavelength than UVB, and will penetrate glass, for example, car windows.
Broadly speaking, there are two types. Skin freckles and sun spots tend to be quite discrete and often superficial and usually respond well to treatment with bleaching creams, light or laser sources, peels or cryotherapy. Melasma is often more irregular and patchy, with usually a mixture of superficial but also deeper pigment.
It may be related to hormones; for example, it is more common in women who are pregnant or are on the oral contraceptive pill. As the pigment is often situated more deeply in the skin, it is harder to remove.
Bleaching agents are often used in this situation, sometimes combined with peeling agents to enhance penetration and effect.
They may need to be continued for a few months and always together with strict sun protection.
All wavelengths of sunlight, including visible light, are capable of inducing melasma, which is why a broad-spectrum sunscreen should be applied at least daily.
Increased sweatiness
Increased sweatiness (hyperhidrosis) - beyond what is expected - of the palms, soles, underarms, face, trunk or everywhere can be a source of embarrassment, for example when offering a sweaty hand to be shaken, or when you get huge sweat marks under your arms in a stressful presentation or interview. It can also affect function, such as when playing the piano or writing on paper during an exam; pencils or even clogs may slip out accidentally.
Sometimes this condition is due to a medical problem such as fever but, for many patients, this is their norm.
The first line of treatment is usually aluminum chloride antiperspirants, but these may be irritating or may not work. They come as sprays, creams, roll-ons and gels.
If this is not enough, then one may try iontophoresis for the palms and the soles, which is the passing of a low-voltage direct electric current across the skin.
One may also try injections of botulinum toxin for the underarms and possibly also for the palms or soles or face, or turn to other interventions, e.g. liposuction ora new device to destroy sweat glands for the underarms, or sympathectomy.
Botulinum toxin injections often need to be repeated at least every year.
Surgical interventions tend to provide a more permanent effect.
Some patients will benefit from tablets called anticholinergics. These may be very effective, but have dose-dependent side-effects like dry mouth or visual disturbances.
Pityriasis versicolor (white spots on tanned skin)
Overgrowth of Malassezia yeast, that lives on everybody’s skin, causes slightly scaly brownish patches - mainly on the trunk - that don’t tan in the sun, so will then appear white in contrast to the surrounding tanned skin. It is associated with high humidity and temperatures.
Predisposing factors include: oily skin as is typical in adolescents and young adults; sweaty skin, eg in athletes who keep a sweaty shirt on too long (shower right after training or at least change into a dry shirt), people who wear overwarm clothing, eg non-cotton undervests, that cause them to sweat; humid skin, eg on the back of girls who leave long wet hair in contact with their skin till it dries naturally.
The condition is treated with antifungal cream for small areas, antifungal shampoo for big areas and for prevention. Antifungal tablets are also very useful for more resistant cases.
White patches will remain even after successful treatment of the fungus, so it is best to prevent! These will eventually fade on their own, but may take many months.
Impetigo
A very contagious bacterial skin infection often seen in children in summer.Summer, with its increased heat and humidity, is the best time for bacteria to proliferate. People with broken skin, like people with untreated eczema, are more prone.
It may also start after an insect bite gets infected, or after trauma to the skin, for instance after a graze from a fall.
Weeping patches with honey-coloured crust or fragile blisters that burst easily to leave sores, appear on the skin, often starting around the nose (the culprit bacteria often come from the warm, moist lining inside the nose).
Antibiotic creams or ointments may be adequate for small and few patches, oral antibiotics are needed for more widespread involvement.People are no longer contagious after 48 hours of treatment or until the sores have dried and healed.
The good news is that the unsightly wounds hardly ever leave any permanent scarring.