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A guide to treating holiday skin conditions

Bevis Man
Communications Officer
British Skin Foundation

The sun can be damaging to the skin, not only in terms of skin cancer risk, but also a variety of dermatological conditions that can be avoided by the patient or treated with some simple advice from the practice nurse

Prickly heat
Prickly heat, commonly known as heat rash (or miliaria) is a red itchy rash that, like the name suggests, causes a slight stinging or prickling sensation on the skin. Although it can affect anyone of any age, it is common in young children and babies whose sweat glands are not yet fully developed.

Causes and symptoms
Excessive sweating can cause sweat glands to become blocked with dead skin cells, which can trap sweat beneath the skin. It is this process that causes the irritation and results in the rash of small red bumps and red skin. When the pockets eventually burst and release sweat, this causes the stinging, prickly sensation.

Prickly heat occurs more frequently in the summertime, owing to increased temperatures, and can affect any part of the body - most commonly the back, neck and armpits. The areas more likely to be affected are those covered by clothing, as this encourages sweating and causes friction against the skin. It can frequently occur on holiday abroad, when a person may sweat more than usual in a hot climate.

Treatment/management
Prickly heat is not a serious condition. In the vast majority of cases it requires little treatment if any, as it tends to heal and disappear of its own accord within a few days. However, there are a number of things patients can do to manage the condition, such as not wearing clothes that are made from synthetic fibres (as these are less breathable), cooling the skin down with cold baths and showers, and generally avoiding the heat and humidity if possible. Carrying a bottle of calamine lotion when going away may be useful, as this can help cool the affected area and offer some light relief.

Photoallergic dermatitis
This condition is caused by the action of sunlight on skin exposed to certain chemicals. The substances that may cause this allergic reaction include perfumes, body lotions or soap, which can make the skin extra sensitive to the sun. It appears as small red blisters or large spots and is not confined to one particular area of the body.

Treatment
The only treatment for photoallergic dermatitis is staying out of the sun, as applying sunscreen may exacerbate the problem due to the chemicals used. When the condition develops, cortiscosteroids can be used to treat the problem, soothing the pain and itch that accompany the rash.

Sunburn
People wrongly associate having a tan with being healthy and we often see people returning from holiday either very tanned or badly burnt (that lobster look). The truth is that tanning is actually a sign that the skin is being damaged. The dark pigment that gives the skin its natural colour is called melanin which is made in the skin by cells called melanocytes. After the skin is exposed to sunlight, the melanocytes make more melanin to try to absorb UV radiation from (over) sun exposure, and so the skin becomes darker or tanned. It's important to point out that getting burnt doesn't always equate to a tan either, as this will depend on skin type. Those with skin types 1 or 2 (fair skin that rarely tans) will burn and not tan (see Table 1).

Causes and effects
In the short term, sunburn can often lead to the skin peeling with the skin appearing red and feeling very sore and hot. In the long term, if people allow themselves to burn, they substantially increase the risk of developing skin cancer at a later stage. Although the peeling and soreness will heal and go, the damage done that is unseen is the most worrying. What's more, over-exposure to UVA radiation from the sun will also accelerate the skin's ageing process, leading to the appearance of leathery skin.

Prevention
It may sound like common sense, but the best way of dealing with sunburn is avoidance. Knowing when to get out of the sun is important. Seeking shade during the hottest parts of the day when the sun is at its strongest is key to preventing sunburn, as are the usual forms of sun protection (clothing, hats, and sunscreen).

After-sun can help cool the burn and restore moisture lost from the skin, but it won't undo the damage caused. Advise patients that peeling skin is certainly not a ‘normal' process; it's a sign that the skin is very badly damaged from the sun. Relying on sunburn that turns into a tan as a means of sun protection is also foolish, as a tan will only offer an SPF of about 2 to 4 at best, which is highly inadequate, regardless of whether you're at home in the UK or abroad.

Treatment
After-sun creams are primarily used to moisturise the skin and may provide some soothing relief from the pain of sunburn. Some after-suns contain antioxidants, which aim to reduce the cellular damage done to skin from sunburn; but the levels of anti-oxidants are unlikely to be high enough to have a significant clinical effect.

For minor to moderate cases, applying cool water to the affected skin or soaking it in a cool bath regularly, followed by the application of after-sun, calamine lotion or a light moisturiser may help to relieve the pain and take the heat out of the burn. Dehydration can also be a problem with sunburn so people should be advised to keep up fluid intake.

In cases of dizzy spells or sickness, or if the skin blisters or is badly swollen, patients should be advised to see their doctor or nurse immediately as they may need medical treatment. Significant or widespread sunburn in children should always be seen by a doctor for immediate medical attention. The same goes for any sunburn at all in babies. Babies and children should never be allowed to burn.

Skin cancer and sun safety
There is certainly a misconception that the sun in the UK isn't as strong as the sun abroad. However, the truth is that it is vital to be as vigilant in terms of covering up and applying sunscreen when in the UK as it is overseas. When it comes to skin cancer, the best method of dealing with it is prevention and knowing what to do to stay safe.

Types of skin cancer
Basal cell cancer is the most common form of skin cancer, and appears as a raised, hard, red area. It is located most frequently on the face, but can appear on other areas of the body. If it is not treated, it can develop into a more serious form of cancer, but basal cell cancer is easily cured and rarely worsens.

Squamous cell cancer is a form of the disease that develops in places where there are visible signs of skin damage, such as blemishes or freckles, most often found on the face, arms, neck and hands. The skin begins to develop into a rough bump with a scaly surface. It may look like a sore that does not heal. It develops at a faster rate than basal cell cancer, but is still considered to be slow growing and, therefore, is easier to spot and treat.

Melanoma is the most serious type of skin cancer. It can be seen in moles that are growing or developing an irregular border. The following ABCD rule should be used when considering whether or not someone is at risk:

  • Asymmetry - the shape of one half does not match the other.
  • Border - the edges are ragged, blurred or irregular.
  • Colour - the colour is uneven and may include shades of black, brown and tan.
  • Diameter - there is a change in size, usually an increase.

If caught early enough, melanoma can be cured, so if a mole looks suspicious, prompt referral to a dermatologist for further investigation is vital.

Sunscreen
A number of factors should be considered when deciding which sunscreen to buy. Having a good understanding of the different skin types is a good start. Those with very fair skin who burn easily and rarely tan are known as skin type 1 (see Table 1). People with this skin type need to take extra care in the sun and should opt for a sunscreen with a high protection (eg, SPF 50). At the other end of the spectrum are those with dark skin who rarely burn (skin type 6). These people may want to use sunscreen (SPF 30) just to be on the safe side when out in the sun for prolonged periods.

[[Tab 1 holiday skin]]

Remember, very young children and babies should never be left in direct sunlight, as they can easily overheat and their skin is also a lot more sensitive and can burn very quickly within a matter of minutes.

For most people, using a sunscreen with an SPF of 30
and a good level of UVA protection (look for four or five UVA
stars, or the UVA circle logo on the label) is sufficient in the summer in the UK. However, a higher SPF can be used, especially if the person is spending a lot of time outdoors. Most people do not apply sunscreen thickly enough to cover their skin adequately; it's important to be generous with the sunscreen and remember to keep reapplying it regularly throughout the day on all members of the family.

The first line of protection against any kind of skin damage in the sun should be to cover exposed skin with loose clothing, and seek out some shade when necessary to prevent the skin from reddening or burning. Wear a wide-brimmed hat that ideally covers the ears and the back of the neck, as these are the two places that are frequently missed when applying sunscreen, and wear sunglasses with UV protection. All of these methods could prove invaluable in preventing sunburn and other holiday skin problems, and lessening future risk of skin cancer.