Show 1479: Must You Shun the Sun to Save Your Skin?

When sunny summer days come around, it makes some dermatologists shudder. They would prefer we behave like bats and hide in caves until nightfall. Failing that, they stress the importance of always applying (and re-applying) high SPF sunscreen, wearing sun-blocking clothing with long sleeves and keeping a big-brimmed hat firmly on the head. A beekeeper’s outfit might be perfect. But must you really shun the sun completely to save your skin? Our guest describes how to practice moderation safely. He also explains why some people are addicted to sunshine, while others are allergic to it.

 

Dermatologists do their best to discourage people from using tanning beds. They describe the damage that ultraviolet light can cause, ranging from wrinkles to skin cancer. For some people, though, those arguments just don’t make a difference. Our guest, Dr. Steve Feldman, conducted a study several years ago. The volunteers were accustomed to using tanning beds. In the study, there were two beds, one with the usual ultraviolet light and the other, identical in appearance and temperature, had its UV blocked. After a session in each bed, volunteers were allowed to choose their bed for the last session. They almost invariably chose the bed with the active UV.

 

To follow up, the researchers administered naltrexone, the opioid-blocking medication. When volunteers had taken it, they were no longer able to distinguish which bed was active. It seems that, for these people, ultraviolet light activates pro-opiomelanocortin, which in turn triggers the production of natural opioids called endorphins. Further research imaging the brain during tanning sessions confirmed that the UV exposure was activating areas of the brain associated with pleasure (Psychiatry Research. Neuroimaging, May 30, 2016).  Dr. Feldman and a colleague found that excessive indoor tanning is similar in pattern to substance use disorders (Journal of Cutaneous Medicine and Surgery, May-June 2025).

Dr. Feldman offers advice on avoiding sunburn that is tempered with this fact from epidemiology: people who go out in the sun live longer (International Journal of Environmental Research and Public Health, July 13, 2020).  The goal here is not to shun the sun completely, but rather to exercise enough caution and good judgment to avoid burning your skin. (Who wants to burn, anyway? It hurts, and it looks bad.) Timing your sun exposure carefully is crucial to save your skin from sunburn. You may also be interested in the new sunscreen ingredient the FDA just approved, bemotrizinol.

When the weather gets hot and bodies get sweaty, heat rash becomes a common complaint. Sweaty skin may develop bumps that can sometimes be very itchy. What do you do to ease the discomfort? If you can cool the skin off, it might help a lot.

 

Of course, people may also suffer from other types of rash. Babies get diaper rash. Women sometimes experience under-breast rash, just as men may develop jock itch. Zinc oxide ointment can often be helpful for these types of rash.

Psoriasis is one of Dr. Feldman’s special research interests. The red scaly plaques of this skin condition have raised borders. They look a lot like a fungal infection, but there is no fungus present on the skin to cause them. Something else seems to trigger the skin’s immune system to react along the same pathways as if there were a fungus.

 

Most of the time, psoriasis is mild enough to manage without costly medications. It actually responds very well to ultraviolet light exposure. UV downregulates the immune system’s over-response. While many dermatologists offer UV exposure within their office walls, in the summertime patients could get exposure to sunlight outdoors. This is practical if they avoid the middle of the day, when they might get burned. Another option? Tanning beds also offer an easy way to calibrate the appropriate amount of UV exposure to save your skin from psoriasis. (Most dermatologists don’t approve of this one, so don’t tell.)

 

One other practical but unorthodox tip for dealing with mild psoriasis. OTC cortisone may not be strong enough to help heal up a red spot. But you could buy Flonase nasal spray or a generic version, fluticasone, over the counter. Spray it on your skin and appreciate the relief. In fact, this could work for a mild case of poison ivy or other skin irritation as well. Severe cases still need a dermatologist’s care.

Atopic dermatitis is the medical term for eczema. People with allergies or asthma also appear to be more vulnerable to eczema. Dysregulation of the immune mediators interleukin 4 (IL4) or IL13 may be responsible. This condition may appear in a mild form, which can be readily managed, or a more severe form that might require prescription medication. A topical corticosteroid such as triamcinolone will often clear it up. Or you could try spraying on some Flonase nasal spray for a cost-effective low-key approach. Those will actually help the majority of people with mild eczema. Using mild soap rather than detergent-based body wash, moisturizing well and following an anti-inflammatory diet are the pillars of home management.

 

People with more severe atopic dermatitis covering a large portion of the body may need powerful prescription medication rather than topical steroids. Trying to cover so much skin with steroid would probably result in side effects from the cream. Dupixent (dupilumab) is a relatively new self-injectable medication that blocks IL4 and IL13. It works well for most people with atopic dermatitis and has a good safety profile. Certain other drugs in this category, such as Skyrizi (risankizumab), are also pretty safe but very pricey. Stelara (ustekinumab), has been around longer. Biosimilars for Stelara have been approved and are more affordable. Ustekinumab blocks IL12 and IL23.

 

TV ads tout other medicines for this condition as well. Rinvoq (upadacitinib) is three or four times more effective than Dupixent, but it is also super expensive. It is a Janus-kinase (JAK) inhibitor. Xeljanz (tofacitinib) is another potent prescription JAK inhibitor, but it carries an elevated risk of heart attack.

Another summer skin hazard is bug bites. Here unquestionably the best approach to save your skin is avoidance. Appropriate clothing is key. (That beekeeper’s suit will come in handy here again.) Dr. Feldman recommends spraying DEET on your pants legs, socks and sleeves rather than directly on your skin. If there are grasses or brush where you have walked, run or played, a tick check immediately upon coming inside is critical.

It doesn’t make sense to tell people to stay off the internet. Some searches can be quite helpful and guide patients in asking their dermatologist the right questions. Dr. Feldman is enthusiastic about DermNet, a New Zealand dermatology website. https://dermnetnz.org  Joe and Terry recommend SkinSight.

Steven R. Feldman, MD, PhD, is Professor of Dermatology, Pathology, and Social Sciences & Health Policy, at the Wake Forest University School of Medicine.  His research has been published in over 1,000 peer reviewed, Medline-referenced articles. Expertscape.com ranks Feldman among the top experts in the world on psoriasis, acne, dermatology, and treatment adherence.

[caption id="attachment_140609" align="alignnone" width="768"] Steve Feldman, MD, in Dermatology clinic, Country Club Commons[/caption]