The question: I seem to have developed a sun allergy over the years and get itchy red skin if I have been out in strong and even not-so-strong sun. I sometimes even get it when it's overcast. My family doctor has prescribed hydrocortisone cream for when it flares up, but I would like to prevent it from happening at all. The itchiness usually lasts a couple of days. When outside, I wear sunscreen fanatically and a hat, but it doesn't seem to do the trick. I don't want to be trapped inside. Would seeing an allergist or a dermatologist help?
The answer: The short answer to your question is yes, seeing a dermatologist may help though it sounds as if your family doctor has already prescribed treatment that works during flare-ups. I don't mean to deter you from seeking out a skin specialist – definitely ask your family doctor about a referral – but I do think you should prepare yourself for what might be a nagging, persistent condition you need to learn to manage.
Toronto dermatologist Anatoli Freiman said you may have a relatively common condition called polymorphous light eruption, which is characterized by red bumps and raised itchy patches after sun exposure, more prevalent in females aged 20 to 40. Its exact cause is unknown but it's thought to be a form of sun sensitivity that's typically more common in spring and early summer.
"It can be quite itchy, quite generalized and cover patients from head to toe," Dr. Freiman said in a telephone interview. "It can become uncomfortable for patients to stay out in the sun."
While many avoid an outbreak by using effective sun protection, others successfully manage to gradually acclimatize their skin by slowly increasing how long they spend outdoors. In your case, it sounds as though you have done everything correctly by wearing sunscreen and a hat.
Treatment involves medium to strong steroid creams or ointments prescribed by your doctor. More severe reactions demand more aggressive therapy, including oral steroids, oral hydroxychloroquine and a specialized form of UVB phototherapy (ultraviolet light treatment), said Dr. Freiman.
"You can get it on a recurrent basis," he said. "Sometimes it's hard to fully prevent it, so we need to work with patients."
While some skin conditions are relatively easy to identify, others can be more challenging; rashes and bumps may look the same but require detective work by a dermatologist.
Dr. Freiman said other causes of sun sensitivity include solar urticaria (a form of sun-induced hives) and systemic conditions, such as connective tissue diseases.
Given that this problem has persisted, you may want to ask your family physician about a referral to a dermatologist. That specialist will come up with a diagnosis and treatment plan. You may need to have further tests. Most likely, you will finally have peace of mind that you have done all that you could to determine the cause of the problem.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org