Have you ever had a client say they went in the sun for just a minute or two and all of a sudden had a sunburn? Having an unexpected sunburn is a classic sign of a photosensitivity reaction. Photosensitivity, or sun sensitivity, is inflammation of the skin induced by the combination of sunlight and, sometimes, certain medications or substances.Have you ever had a client say they went in the sun for just a minute or two and all of a sudden had a sunburn? Having an unexpected sunburn is a classic sign of a photosensitivity reaction. Photosensitivity, or sun sensitivity, is inflammation of the skin induced by the combination of sunlight and, sometimes, certain medications or substances.

TYPES OF PHOTOSENSITIVITY

There are a few different types of photosensitivity. Solar urticaria develops large, very itchy hives or red welts after only a few minutes of sun exposure. Depending on the individualperson, the hives could last a few minutes or a few hours. And, if the sun exposure is great enough, it can have systemic effects and cause headaches, nausea, weakness, dizziness, and respiratory issues like wheezing. Furthermore, if people an individual isare prone to this skin condition, they may have it for many years or, sometimes, their entire lifves. Solar urticaria photosensitivity does not involve external chemicals – just the body’s own immune system reaction to ultraviolet exposure.Polymorphous light eruption is the most common type of photosensitivity and it shows up as tiny, red dots about 30 minutes after being in the sun. It differs from solar urticaria in that the individual person having the reaction typically gets it less and less the more often they are in the sun. They build up more of an immunity to the reaction also referred to as hardening. Chemical- induced photosensitivity happens after a drug or chemical agent combines with ultraviolet radiation to cause a photo-toxic or allergic reaction. Photo-toxicity occurs after a person has taken an oral medication or applied a chemical to their skin. This inflammatory reaction causes the skin to turn red, which looks like a sunburn. Sometimes, this type of skin reaction can even turn brown, blue, or grey. Photo-allergy is a photosensitivity reaction that happens after chemicals on the skin (, like sunscreens, aftershaves, and other ingredients, like sulfonamides,) react with the sun. Again, a sunburn-like reaction may occur but this time with a stinging or burning sensation, rash, itching, dryness, swelling, and even blisters. The first time a client learns that sunscreens could cause a photosensitivity reaction, they maybe shocked because sunscreen is obviously made to protect skin from the sun’s harmful ultraviolet rays. However, not all sunscreens are made the same. Some sunscreens are made in a laboratory and tested under lights that are not true to real life conditions, including ultraviolet ray, heat, and sweat. This is why it is imperative to choose a sunscreen that is not expired and is created by a reputable company. Some may even have a label that says Skin Cancer Foundation Approved, which means it has undergone additional testing. This does not mean that sunscreens without this approval are not good or effective; , as because it can be a very time consuming and costly process, especially for a startup or smaller boutique skin care company.

IDENTIFYING PHOTOSENSITIVITY

Being able to identify when a client is having a photosensitivity reaction is important, but more important is being able to prevent them. Some of the most common causes of photosensitivity reactions seen in the skin care industry are caused by topical products, topical and oral medications, and corrective treatments. Clients should always be referred to their physician if they have flu-like symptoms, including fever with chills, nausea, headache, and weakness. 

TOPICAL PRODUCTS

Topical products that cause photosensitivity include common acne ingredients like retinol, benzoyl peroxide, and glycolic and salicylic acids. Both alpha hydroxy acids and beta hydroxy acids exfoliate the skin, removing the natural protective barrier and making the skin more sensitive to sunlight. They can be found in cleansers, spot treatments, chemical peels, and even corrective hydrators. Benzoyl peroxide, while mainly killing bacteria, can also remove theat top layer of skin, making a client more prone to a sunburn. Retinoids are some of the biggest offenders, as this class includes the stronger prescription strength Retin-A. Remember, Retin-A increases cell turnover and exfoliates from the inside out, and pushing new cells up at a faster rate. These new cells are incredibly sensitive to the sun. This is why it is imperative to recommend sunscreen with retinol and Retin-A use. When treating acne, sometimes it has to be hit from all directions:, the oil, the bacteria, and the buildup of dead skin. This can lead to an aggressive treatment protocol that involves not only topical products, but also the use of exfoliating treatments and oral medication. When Retin-A or retinol is combined with the oral medication Accutane, this combination has one of the highest documented occurrences of photosensitivity reactions. Accutane, or Isotretinoin, is a medication used to treat cystic acne by slowing down the oil production and can be very hard on the body. It is recommended to avoid the sun for at least three to six months after taking the last dose of Accutane. Other photosensitizing oral medications used to treat acne are antibiotics, which include doxycycline, tetracycline, minocycline, and erythromycin. Watch outLook for these ingredients listed on client intake forms and educate clients that those particular medications are going to make themir skin more sensitive to the sun. This also means they are going to be more sensitive to professional treatments. This means that if performing a chemical peel or laser treatment on them, they may turn pink or respond quicker than normally anticipated. Only one to two layers of peel might be able to be applied, instead of three or four. Skin care professionals might also need to turn their energy setting down by 20% to 30%. If a skin care professional is aware that the client is on these products and medications,, skin care professionals can perform treatments can be performed with more caution. Consider doing a patch test a few days before the treatment to give a baseline and prevent complications.

SUN-SENSITIVE TREATMENTS

Treatments like microdermabrasion and chemical peels work by exfoliating the skin, thereby making it more sun sensitive, just like alpha hydroxy acids and beta hydroxy acids. It is recommended to avoid the sun for 14 days before prior and 14 days after a treatment. Pigment controlling ingredients, that lighten the skin, like vitamin cC, arbutin, or hydroquinone, that lightening the skin, shut down the melanin process, reducing brown spots and creating a more even skin tone. While these ingredients are not at the top of the list for being photosensitizing, they do decrease melanin, which is the skin’s natural sun protection and can make clients more sensitive to the sun in general, so be mindful and educate for daily sunscreen use. Other common medical spa treatments are lasers and intense pulsed light. These energy- based treatments use light and heat to create a change in the skin. When the client has a light- based treatment and then goes into the sun, they are at a high risk for having a photosensitivity reaction since they are putting light on top of light – or ultraviolet on top of the heat made from the laser used in the officetreatment room. This can lead to a burn or a blister even days after a treatment. Sometimes hypopigmentation can result after blisters are healed. This type of hypopigmentation cannot be corrected or reversed.

ESSNENTIAL OILS

Essential oils are big rightvery popular now, for both in-office and at-home treatments. Some common essential oils that cause photosensitivity are bergamot, bitter orange, grapefruit, lemon, lime, and mandarin leaf. For those clients that are making their own do-it-yourself scrubs, masks, and lotions, they may find these ingredients in there. 

PREVENTION

The best way to prevent photosensitivity is to avoid it. Through communication and education, . Hhave a thorough consultation to learn all the medications, products, and treatments the client is receiving. Then, educate the client on how their products work and which ones are more sun-sensitive. These include exfoliators, salicylic acid, glycolic acid, and even lactic acid. Benzoyl peroxide can also be irritating. Ingredients like peptides and growth factors are generally not going to be sensitizing. With retinol, a good rule of thumb is to only use it at nighttime and not during the day. Discontinuing the use of retinol three to five days before a treatment will reduce sensitivity in the treatment room. After they have a treatment, ensure they clients avoid the sun for 10 to 14 days afterward, depending on the service they received. Supply post-treatment products and instructions. This ensures that the client does not use any other chemicals or ingredients that could interfere with the treatment that was just performed on their skin. The post-procedure products could include a gentle cleanser, a 0.5% hydrocortisone, a hydrator, and a sunscreenn SPF. Often, with chemical peels, the company vendorskin care manufacturer will provide their own post-peel kits. With ablative lasers and microneedling, I consider using a baby shampoo for the cleanser and aquaphor as a staple to get the area hydrated with a thicker hydrator that the skin can still breathe through.

TREATING PHOTOSENSITIVITY

If photosensitivity does occur, it appears within 24 hours of sun exposure and resolves when the blisters from the rash peel and slough off. It is treated as one would treat a sunburn. 

Here are some tips on how to help treat photosensitivity reaction.

1. Stay inside and away from the sun. 

2. Take a cool shower or bath. This will help decrease pain from the heat. Afterwards, pat dry – , do not rub skin – , and apply an aloe- or water-based moisturizer. If possible, leave a little of the moisture on the skin after from the shower to use as a base for lotion. 

3. Apply an aloe- or water-based hydrator. Do not use lidocaine, benzocaine, Neosporin, polysporin, or an oil-based lotion. The skin needs to be able to breathe and heal.

 4. Drink plenty of water. It is imperative to stay hydrated. When the skin is injured, it loses a lot of water and causes dehydration. Drinking water and eating protein helps skin heal at a quicker rate. 

5. If the skin has blisters, they should not be popped do not pop them. If there is loose skin from a popped blister, it should not be picked or pulled.do not pick or pull at loose skin.  This may cause hyper- or hypo-pigmentation. Let the skin heal itself and if there are some pigment issues, then address those later after it has healed.

6. While the skin is healing and still pink, take extra added precaution to protect from any additional heat, light, and trauma. Wear loose clothing that will not rub the affected area, but also ensure the area is not getting sun or chemicals on it. Wear clothing that is thick enough that light does not go through it to prevent additional ultraviolet damage without having to apply a chemical sun protectant factor sunscreen. 

EDUCATION

Having an unexpected reaction is always scary for a client, so being able to educate them on how to avoid this is going to be the best path for both parties. As the sunny summer season draws near, put together summer-friendly protocols and specials and remember guidelines for sunscreen. The American Academy of Dermatology recommends everyone use sunscreen that offers broad-spectrum protection (protecting against UVA and UVB rays) and a sun protection factor n SPF of 30 or higher with water resistance. Reapply every two hours when in direct sunlight. The Federal Drug Administration requires that all sunscreens retain their original strength for at least three years. If the expiration date has passed, do not use it and throw it away. If it does not come with an expiration date, write down the purchased date and the date it was opened. Also, check for obvious signs that it is expired, like smell, color, and consistency. 
Photosensitivity may be something many are unfamiliar with, but as professionals educate themselves and their clients on the causes, preventive measures, and treatments, they can ensure the best outcomes for their clients.

Erin Lucie, an Oklahoma native, is a family nurse practitioner and licensed cosmetologist with over 15 years of experience in the aesthetics industry. Known in Tulsa as an expert cosmetic injector, she completed her Botox and filler training in Beverly Hills, California in 2011 and has attended many advanced trainings since. Lucie has further specialized in optimizing and balancing the hormone dysfunction created by stress and the overwhelming life management issues relating to all professionals by providing clients with integrative options in health, lifestyle, medication, and appearance enhancement. She is a member of the American Academy of Anti-Aging Medicine.