Lupus, psoriatic arthritis, and scleroderma are several types of arthritis that make people more sensitive to sunlight – either because of arthritis itself or the medications they take to treat it. It is important for these people to include sun protection as part of their self-management plan.
The sun radiates two types of “invisible” ultraviolet light that are harmful if you are exposed to it for a long period of time – ultraviolet A (UVA) can age the skin and ultraviolet B (UVB) can burn the skin. Both UVA and UVB can alter the DNA of skin cells, increasing the risk of skin cancer. For people living with lupus, psoriatic arthritis or scleroderma, sun exposure can make symptoms worse or increase damage to skin cells.
Sun sensitivity is a hallmark of lupus. People with lupus experience one or many of these symptoms:
- “butterfly” rash over the bridge of the nose and the upper cheeks
- scaly, purplish lesions on the face and neck
- red, circular rashes on the chest, back and arms
Sun exposure can bring on these rashes or make existing rashes worse. Those with systemic lupus erythematosus find that exposure to the sun triggers a flare, including joint pain, fatigue, and fever.
Scleroderma is an autoimmune rheumatic disease in which skin of the extremities, chest, abdomen, and/or face becomes thick and hard and, in some cases, discoloured. Joint pain and stiffness, particularly involving the hand joints, is almost always present at disease onset. Some people find that sun exposure further damages or discolours their skin. To learn more about scleroderma, read Arthritis Consumer Experts’ “Spotlight on scleroderma”.
Ultraviolet A rays may improve psoriatic arthritis and psoriasis skin symptoms, such as dry and scaly skin. The sun and humidity of summer may bring relief from the dry and itchy skin. However, overexposure to the sun can damage skin cells and make the disease worse. Some people are so sensitive to the sun that they avoid unnecessary sun exposure. It will be worthwhile to monitor your symptoms and consult your rheumatologist or dermatologist if you are concerned about exposure to sunlight.
Medications used to treat arthritis may increase the skin’s sensitivity to the sun. Pain-Free Living provides a list of some of the medications that may put you at a higher risk of skin redness and burning:
- nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin), naproxen (Aleve, etc.) and celecoxib (Celebrex) used to reduce pain and inflammation in all types of arthritis
- antimalarial drugs such as chloroquine (Aralen) and hydroxychloroquine (Plaquenil) used to treat lupus and rheumatoid arthritis
- sulfasalazine (Azulfidine) and methotrexate (Rheumatrex, Trexall, etc.) used to treat rheumatoid arthritis
- diuretics (for high blood pressure), sulfonylureas (for diabetes)
- tricyclic antidepressants, antihistamines, antibiotics, cardiac medications
You should always check the label of your medications for possible side effects and discuss any concerns you may have with your physician.
Tips to protect against harmful ultraviolet lights
- Plan your outdoor activities accordingly. Avoid the midday sun, where the sun is strongest, between the hours of 10 AM and 4 PM.
- Apply sunscreen with a sun protection factor (SPF) of at least SPF 15. Use sunscreen even if it’s cloudy and in winter as the snow can reflect ultraviolet light. Apply sunscreen liberally and reapply every two to three hours.
- Sweat and water activities can reduce the effectiveness of sunscreen. “Water-resistant” sunscreen typically means the sunscreen will last about 40 minutes in the water. “Waterproof” means it will last for about 80 minutes. No sunscreen is completely waterproof. Be wary of claims that say “all-day protection”.
- Find a sunscreen that protects against UVA and UVB rays. A UVA-blocking sunscreen should contain at least one of the following ingredients: avobenzone, ecamsule (Mexoryl), titanium dioxide, or zinc oxide.
- Cover up by dressing appropriately, such as wearing a loose-fitting, long-sleeved shirt, large or full-brimmed hats, sunglasses, or clothing with UV protection. Using an umbrella with UV protection can help too, especially if you are sensitive to sunscreen.
- When participating in outdoor activities, ensure to have some shade protection from trees, buildings, tents or beach umbrellas.
- It is important to note that there are other possible sources of ultraviolet light, including fluorescent light bulbs and photocopy machines. A small percentage of people with arthritis may be affected by ultraviolet lights emitted from these sources. To protect yourself, use “covered” fluorescent bulbs and wear sunscreen if you expect to be near a fluorescent light source for a long period of time. Natural Resources Canada provides a helpful factsheet about compact fluorescent light bulbs (note the section on page 2 about ultraviolet emissions).
The importance of Vitamin D
Vitamin D is essential for the absorption of calcium. Calcium helps keep bones strong and prevent osteoporosis. Adults, 19-50 years need 400 IU per day and adults 51 years and older require 800 IU per day. Vitamin D can be obtained through dietary sources such as milk (100 IU/cup). If you need to supplement your vitamin D intake, use a multivitamin. Remember that milk used in coffee, cereal, soups, puddings etc. counts too.
It is important to remember not to exceed the recommended dosages of calcium and vitamin D. Although vitamin D is essential, research has shown that doses higher than 2000 IU can have side effects of toxicity and create other complications, including bone loss.
Vitamin D is also absorbed through our skin from sunlight. However, as we get older our skin’s ability to make vitamin D decreases. Canadians, because of our physical location on the Earth, cannot make Vitamin D through our skin from early November until early March.
Try to take advantage of the warm weather. Try to sit out in the sunlight 10-15 minutes a day and expose your arms and legs. Remember to apply sunscreen to your face but not to your arms and legs during this time. Sunscreen blocks the absorption of vitamin D.
Research suggests that if you have sensitive skin, sit out twice/week for 10-15 minutes and use a sunscreen with SPF at least 15. For this short time, you will not burn or predispose yourself to skin cancer. If you have an existing skin condition, you should speak to your doctor before sitting out in the sun.