Saturday, March 17, 2012

Lupus and sun sensitivity

This is a very hard symptom of lupus to deal with in my opinion.  I can't tell you how many times I have been out during a sunny day with sunscreen, a hat, and using a special SPF umbrella, just to get sick and a rash.  The exposure makes me feel drained, sick, dizzy and I must lie down, not to mention the beautiful rashes that pop up.  My medications have helped my sensitivity, for instance, I can sit in my car on a sunny day and not feel like the sun is burning my skin, or feel sick after just 5 minutes of driving.

Sensitivity to Light

Two-thirds of people with lupus have increased sensitivity to ultraviolet rays, either from sunlight or from artificial inside light, such as fluorescent light, or both. Whether or not you are photosensitive you should limit your exposure to ultraviolet rays, especially outdoors, as excessive exposure to the sun can cause lupus to flare.
Everyone with lupus who is going to be outside for more than a few minutes should use a sunscreen with a sun protection factor (SPF) of at least 30 that blocks both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Sunscreen should be applied thoroughly, especially to your neck, temples, and ears -- areas that are often affected by lupus skin problems.
Wearing proper clothing helps, too, such as broad-brimmed hats, long-sleeved shirts, and long pants. If you spend a large amount of time outdoors, you should wear clothing made of sun-protective fabric. Sunbrellas, which are umbrellas made with sun-protective fabric, are also available.
Since UVB rays are most intense between the hours of 10 a.m. and 4 p.m., you should try to plan your outdoor activities for early in the morning, late in the afternoon, or in the evening. Also be aware that UV rays are stronger at higher altitudes and when they are reflected by snow or water.
Ultraviolet rays are also given off by indoor fluorescent lighting commonly found in offices and stores. Light shields that cover fluorescent bulbs can be ordered from several different manufacturers. If you are affected by light sensitivity, look for light shields that have nanometer readings of 380 to 400. This ensures complete filtering of UVB and UVC (especially damaging to exposed skin cells), and almost all UVA. If you are extremely sensitive to light, you may want to consider wearing a broad-brimmed hat when visiting brightly lit stores or other public places.

Lupus and Light Sensitivity

Systemic lupus erythematosus (SLE or lupus) is a multisystem disease with a tendency to cause skin rashes. These often appear on light exposed skin after exposure to sunlight (for example face, neck, hands, and feet). These rashes are called photosensitive rashes and are one of the hallmarks of the disease (see relevant lupus fact sheet). Some patients complain of feeling unwell after going out in the sun, even for relatively short periods of time (such as half an hour). For example, they may develop migraine, nausea (feeling sick) or joint pains. The joints may even become tender to touch and swollen. A true attack of arthritis due to increased activity of the disease (a flare) may follow. These are all manifestations of light sensitivity in lupus patients. Other aspects of the disease may deteriorate after sun exposure, including fever, pleurisy (chest pains on breathing in), kidney disease and more serious nervous system problems such as epilepsy (fits). Occasionally, patients are sensitive to fluorescent lighting but this is much less common than sun sensitivity.
What is it in sunlight that causes lupus to flare and causes rashes to develop in particular?
It is the ultraviolet (UV) waves in the sunlight. Ultraviolet light in the UVA and UVB wavebands is responsible. UV light damages cells in the skin (keratinocytes) causing them to die. In healthy people without lupus, these dead cells are cleared away quickly and any inflammation induced by the sun-induced skin damage is short-lived (sunburn).
However in lupus patients, the skin cells may be more sensitive to sun-induced damage and there is increasing evidence that the dying (apoptotic) cells are not cleared away efficiently. As a result the contents of the dying cells may be released and cause inflammation. Also, cell contents such as DNA (the genetic material) and other molecules including Ro which are never normally exposed to cells of the immune system are available to generate (start) an immune response. Immune responses and inflammation are the normal reactions of the body to infection, but here they are being generated inappropriately by the dying cells and the body mounts an immune response against its own cell constituents (autoimmunity). The end result of this process in susceptible people with certain types of lupus is the development of characteristic photosensitive rashes. Antibodies to Ro, in particular, are often found in people with these rashes. Why the rashes affect only some parts of the body at any one time and are not always sun-sensitive is still not understood.
Why do some people with lupus get other disease manifestations after sun exposure?
The immune response to cell constituents results in the formation of these special proteins called antibodies. The antibodies are made by white blood cells called lymphocytes that circulate in the blood and both the lymphocytes and the antibodies can travel to different parts of the body.
These antibodies in lupus are directed against, and bind to, particular molecules such as DNA and Ro. These cell constituents may be released by other dying cells in the body as it appears that the inability to clear dying cells is not limited to the skin. Wherever the antibodies and their target molecules meet up and bind together, an immune complex is formed which can set up a series of inflammatory processes causing disease manifestations in that part of the body. Having said this, it is still not entirely clear why different people with lupus get certain disease manifestations and not others.
Do all lupus patients suffer from light sensitivity?
No, about 60% of lupus patients get sun-induced rashes and a further 10-20% complain of other clearly sun-induced problems. The role of sunlight in the remainder is unclear. Only a few people are confident that sun exposure definitely does not affect them, as they can go out for long periods and sunbathe without any ill-effects then or in the following weeks. Because new immune responses can take over a week to develop, the effects of sunlight will not necessarily be on the same day. In general, all lupus patients are advised to avoid sun exposure as it is one of the easiest ways of avoiding something which we know can make lupus worse in many sufferers.
Can photosensitive rashes and other sun-induced manifestations of lupus be prevented?
Yes, to a large extent photosensitive rashes and other sun-induced problems can be prevented by keeping sun exposure to a minimum and using sunblock regularly in the summer months (often from April to October). This also means not going to hot sunny countries or mountainous areas where there is more UV light than in the UK. In particular, beware the increased UV exposure with snow, sea or other water due to additional light reflected on to the body (especially the neck and chin!). Even in the UK, it is wise to avoid going out in the sun in the middle of the day in summer. Sunblock should be sun protection factor (SPF) 25 or greater and effective against UVA and UVB light. It should be put on in the morning and reapplied during the day (at least once or twice) as it tends to get rubbed off or sweated away, particularly in warm weather, and don't forget your hands and feet! Sunblock should be used even on cloudy days by light-sensitive people because UV light can penetrate the cloud layer and you can never tell what the weather will be like later on. It is also advisable to cover up with long sleeves and trousers and wear a wide-brimmed hat when out in the sun. The use of UV film on windows may also be necessary for those who are particularly sun-sensitive.
How can I afford to buy so much sunblock?
Certain types of sunblock are available on prescription for people with a sun-induced disease like lupus. The general practitioner (GP) usually prescribes the sunblock but the GP may want advice from a hospital specialist about which one to prescribe, how often and for how long. If you prefer a particular sunblock that is not available on prescription then you will have to pay for it yourself.
Do drugs provide protection against sun-induced flares of disease?
Yes, some drugs do help by damping down the immune responses and inflammatory processes. Steroids (for example prednisolone) will help to prevent and treat lupus manifestations due to sunlight. However, it is always best to be on the smallest possible dose of steroids, so avoiding UV light and wearing sunblock is important even if you are on steroids. Hydroxychloroquine (Plaquenil) seems to be particularly helpful at preventing rashes, arthritis and pleurisy which may be sun-induced, but is not a replacement for sensible behaviour. Other drugs (such as azathioprine, methotrexate, cyclophosphamide) which are often used for more serious disease or to keep the dose of steroids as low as possible may also reduce the risks of sun-induced flares. 

The New Sunscreen Guidelines

New requirements on sunscreen labels were established to better protect our skin. Learn what the changes mean for you.
By Otesa Middleton Miles
Figuring out which sunscreens reduce your risk of skin cancer, sunburn and early skin aging may be easier now than ever. The U.S. Food and Drug Administration, or FDA, now requires sunscreen makers to follow new rules regarding the way skin protection is described on sunscreen labels.
Reynold Tan, PhD, a U.S. Food and Drug Administration interdisciplinary scientist, says this is the first major overhaul of sunscreen labeling in more than 30 years. “It’s pretty much been an open field,” says Tan, who is in the agency’s nonprescription drug office.
The FDA recommends people use sunscreen that is broad spectrum, which provides protection against both ultraviolet A rays and ultraviolet B rays, with sun protection factor, or SPF, of 15 or higher, combined with “other sun-protection measures, such as limiting time in the midday sun from 10 a.m. to 2 p.m. and wearing protective clothing including hats and sunglasses,” says Tan.
The new labels should prove especially helpful to those with autoimmune conditions and/or arthritis who have increased sensitivity to the sun either because of their conditions and/or as a result of medications such as some non-steroidal anti-inflammatory drugs and methotrexate, which can make the skin more susceptible to damage.
Rheumatologists urge people with autoimmune diseases such as lupus, also called systemic lupus erythematosus, or SLE, and those taking medications that cause photosensitivity, to use a sunscreen with an SPF,of 30 or higher.
“The new FDA guidelines are important for people with photosensitivity from conditions such as SLE and for patients with rheumatoid arthritis and other autoimmune diseases that may be treated with medications that increase photosensitivity because they now require the labeling to reflect the level of both UVA and UVB sun protection which both play a role in photosensitivity,” says Soumya Reddy, MD, a rheumatologist and assistant professor of medicine and dermatology at the New York University Langone Medical Center.

The 21 Most Affordable Natural Sunscreens

Natural sunscreens, made with organic and mineral sunblocks, are free of worrisome ingredients - but can cost an arm and a leg. Not these top-rated sunscreens: Each costs $6 an ounce or less.

1 of 22

Best Natural Sunscreens

For safe summer fun, you want to protect your skin. After all, more than 1 million new cases of skin cancer are diagnosed in the U.S. every year. Prevention means blocking not only UVB radiation, but UVA radiation too, too. But it also means steering clear of suspect chemicals that the Food and Drug Administration and manufacturers might feel are ok, but that worry watchdogs. Those suspect ingredients include oxybenzone, which could disrupt the human hormonal system, and Vitamin A (retinyl palmitate), which may boost skin cancer risk. (Though Good Housekeeping talked to a noted researcher who said retinyl palmitate is probably safe.)
But you also don't want to pay more than you have to for protection, and some of the natural sunscreens on the market are quite expensive. That's why we took the best-rated mineral sunblocks (with zinc or titanium) from the Environmental Working Group's annual Sunscreen Guide and did some price comparisons. (While watchdogs worry that the nanotechnology that makes most mineral sunscreens is inadequately regulated, they're considered the safest options on the market.) You'll find here, in order starting with the least expensive, only sunscreens that sell for $6 an ounce or less.
Remember, though, "the best sunscreen is a hat and a shirt," as Environmental Working Group puts it.

Read more:

Top Sunscreens
Our top-rated sunscreens contain the minerals zinc or titanium. They are the right choices for people who want the best UVA protection without any chemical considered to be a potential hormone disruptor. None of the products contain oxybenzone or vitamin A, and none are sprayed or powdered.

The 188 best beach & sport sunscreens (brands sorted A-Z reverse)
See all beach & sport sunscreens »
 Product and Score
product imageAdorable Baby
Clear Baby Sunscreen Stick, SPF 30+
Clear Baby Sunscreen, SPF 30+
product imageAlba Botanica
Natural Very Emollient Sunblock, Kids Mineral Protection, SPF 30
Natural Very Emollient Sunblock, Fragrance Free, SPF 30
product imageAll Terrain
TerraSport Face Stick Skin Protectant, SPF 28
KidSport Sunscreen Stick Skin Protectant, SPF 28
Show 8 more
product imageAubrey Organics
Natural Sun Green Tea Sunscreen, SPF 30+
Natural Sun Sports Stick Unscented Sunscreen, SPF 30+
Show 3 more
product imageAveeno
Baby Natural Protection MineralBlock Face Stick, SPF 50+
product imageBabyGanics
Cover Up Baby Sunscreen for Face & Body, Fragrance Free, SPF 50+
Cover Up Baby Sunscreen Stick, SPF 50
Cover Up Baby Sunscreen Moisturizing Lotion, SPF 50
product imagebabyUV/kidsUV inc.
KidsUV Natural Sunscreen, Blue, SPF 30
KidsUV Natural Sunscreen, Pink, SPF 30
product imageBadger
Lightly Scented Lavender Sunscreen, SPF 30
Baby Sunscreen, Chamomile & Calendula, SPF 30+
Show 15 more
product imageBeyond Coastal
Kids Natural Sunscreen, SPF 30+
Natural Sunscreen, SPF 30+
product imageBlue Lizard
Australian Sunscreen, Face, SPF 30+
product imageBurnOut
Kids Physical Sunscreen, SPF 30+
Ocean Tested Physical Sunscreen, SPF 30+
Clean and Clear Zinc Oxide Sunblock, SPF 32
product imageBurt's Bees
Baby Bee Sunscreen Stick, SPF 30
product imageCalifornia Baby
Everyday/Year-round Sunscreen Stick, SPF 30+
No Fragrance Sunscreen Stick, SPF 30+
Show 4 more
product imageCaribbean Solutions
Sol Kid Kare Biodegradable Sunscreen, SPF 25
product imageClimb On!
Mineral Sunscreen, SPF 30
product imageColor Me Pink
Baby UV/ Kids UV 100% Natural Sunscreen, SPF 30
product imageCOOLA
Plant UV Body Sunscreen, Unscented, SPF 30
Suncare Face Plant UV Sunscreen, Unscented, SPF 30
Show 2 more
product imageCoppertone
Sensitive Skin Faces Sunscreen Lotion, SPF 50
Kids Pure & Simple Sunscreen Lotion, SPF 50
Show 2 more
product imageDesert Essence
Organics Age Reversal Mineral Sunscreen, SPF 30
product imageDO Naturals
Dolphin Organics Naturals Mineral Sunscreen, SPF 32
product imageDr. Robin For Kids
Sunscreen for Children, SPF 30+
product imageEarth's Best
Mineral Sunscreen, SPF 30
Organic Sunblock, Chemical Free, SPF 30+
product imageECO logical skin care
Baby All Natural Sunscreen, SPF 30+
Body All Natural Sunscreen, SPF 30+
Face All Natural Sunscreen Lotion, SPF 30+
product imageElemental Herbs
Sunstick Zinc Sunscreen, Unscented, SPF 30
Sunscreen, Kids, SPF 30
Show 2 more
product imageEltaMD
UV Pure Broad-Spectrum, SPF 47
UV Physical Broad-Spectrum, SPF 41
product imageEpisencial
Broad Spectrum Sunscreen, SPF 35
Sunny Sunscreen, SPF 35
product imageErbaviva
Natural Sunscreen for Children & Adults, SPF 15
product imageFallene
Cotz 20% Zinc Oxide Vanishing Formula Pure Mineral Sun Protection, SPF 35
Cotz Face Water Resistant Sun Protection, SPF 40
product imageGlory
For Girls All The Time Sun Screen, SPF 30
product imageGoddess Garden
Baby Natural Sunscreen, SPF 30
Natural Sunscreen, SPF 30
Show 3 more
product imageHara Body Care
Hara Sport Sunscreen, SPF 30
product imageHealing-Scents
Live Long Mineral-Based Sunscreen, SPF 25
product imageJason Natural Cosmetics
Sunbrellas Mineral Natural Sunblock, SPF 30
Pure Natural Sun: Mineral Natural Sunscreen, SPF 30
Natural Mineral Sunscreen, SPF 30
product imageKabana Skin Care
Green Screen Organic Sunscreen, Tinted, SPF 22
Green Screen Organic Sunscreen Original, SPF 20
product imageKaren's Botanicals
Simple Sun Block, Unscented, SPF 30
product imageKiss My Face
Kids 100% Natural Mineral Sunblock SunStick, Blue, SPF 30
Kids 100% Natural Mineral Sunblock SunStick, Pink, SPF 30
Show 3 more
product imageLa Roche-Posay
Anthelios 40 Sunscreen Cream, SPF 40
product imageLaVanila Laboratories
The Healthy Sun Screen Body Cream, SPF 30
The Healthy Baby Block, SPF 40
The Healthy Sun Screen Face Cream, SPF 40
product imageLittle Forest
Sunscreen Lotion For Babies and Kids, SPF 30+
product imageLoving Naturals
Clear Face Sunscreen, SPF 30+
Sunscreen, SPF 30+
Show 2 more
product imageMarie Veronique Organics
Kid Safe Screen, SPF 25+
product imageMaui Natural Organics
All Natural Sunscreen Lotion, SPF 30
Surfer Honey Natural Sunscreen, SPF 30
product imageMDSolarSciences
MD Solarsciences Natural Mineral Sunscreen Stick, SPF 40+
MD Solarsciences Mineral Screen Gel, SPF 30+
Show 3 more
product imageMustela
High Protection Sun Lotion, Bebe/Enfant, SPF 50
Sun Cream for Sensitive Areas, Bebe/Enfant, SPF 50
product imageNature's Gate
Aqua Block Sunscreen Lotion, SPF 50
product imageOwn
Active Sun Ball Sun Block, SPF 30
Invisible Face and Body Block Lotion, SPF 30
product imagePoofy Organics
The Sunscreen Stick, SPF 30
The Sunscreen, SPF 30
product imagePurple Prairie Botanicals
SunStick Mineral Stick, SPF 30
SunStuff Mineral Lotion, SPF 30
product imageRaw Elements USA
product imageReleve' Organic Skincare
by Emerald Essentials Sun-Lite Sunscreen, SPF 20
product imageSeventh Generation
Baby Sunscreen, SPF 30
product imageSmart Kids who Play
Face Stick, SPF 30+
product imageSolar Sense
Zany Zinc Colored Sunscreen, Blue, SPF 50
Zany Zinc Colored Sunscreen, Pink, SPF 50
Zany Zinc Colored Sunscreen, Yellow, SPF 50
product imageSolbar
Shield Sunscreen, SPF 40
product imageSoleil Organique
Soleil Organique 100% Mineral Sunblock for Face, SPF 45
Soleil Organique 100% Mineral Sunblock for Body, SPF 45
product imageStar Naturals
Baby Natural Sunscreen Stick, SPF 25
Natural Sunscreen Stick, SPF 25
product imageSun Bunnies
100% All Natural Sunscreen Lotion, SPF 30
product imageSunbow
Dora the Explorer Sunscreen, Pink, SPF 30
SpongeBob Square Pants Sunscreen, SPF 30
product imageSunology
Natural Sunblock Creme for Kids, SPF 50
Sport Stick, SPF 35
Lotion for Body, SPF 50
product imageSuntegrity Skincare
Baby Natural Mineral Sunscreen, SPF 30
Natural Mineral Sunscreen For Body, SPF 30
Show 3 more
product imagesunumbra
Natural sunscreen with organic ingredients, SPF 30+
sunkids Natural sunscreen with organic ingredients, SPF 40+
product imageSupergoop!
Antioxidant-Infused Sunscreen Day Cream, SPF 50
product imageSweetsation Therapy
Sun*Si'Belle+ Organic Triple Action Moisturizing Sunscreen, SPF 50+
Sun*Si'Belle Organic Triple Action Moisturizing Sunscreen, Scent-Free, SPF 30+
Show 2 more
product imageThe Honest Company
Sunscreen, SPF 20
product imagethinkbaby
Sunscreen Benefiting Livestrong, SPF 50+
product imagethinksport
Kids Sunscreen Benefiting Livestrong, SPF 50+
Livestrong Sunscreen, SPF 50+
Sunscreen Benefiting Livestrong, SPF 50+
product imageTropical Sands
Face Stick, SPF 30
Sunscreen, SPF 50
Broad Spectrum Sunscreen, SPF 30
product imageTruBaby
Water & Play Mineral Sunscreen, SPF 30+
Everyday Play Mineral Sunscreen, SPF 30+
product imageTrue Natural Cosmetics
All Natural Active Sunscreen, SPF 40
True Natural Broad Spectrum Baby & Sensitive Skin Sunscreen Lotion, SPF 50
Show 2 more
product imageTrukid
Sunny Days Sport Sunscreen, Unscented, SPF 30+
New Sunny Days Mineral All Natural Sunscreen Lotion, SPF 30+
Show 2 more
product imageTruVillage
SafeSun Naturals Sport Sunscreen Lotion, SPF 30+
SafeSun Naturals Sunscreen Lotion, SPF 30+
product imageUV Natural
Sunscreen Lotion, SPF 30+
Baby Sunscreen, SPF 30+
Sport Sunscreen Lotion, SPF 30+
product imageVanicream
Sport Sunscreen Lotion, SPF 35
Sunscreen Lotion, SPF 30
product imageVMV Hypoallergenics
Armada Baby Sunscreen Lotion, SPF 50+
product imageWOTNOT
Natural Sunscreen, SPF 30+

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