Alerting Patients to the Hazards of the Sun

The sun is shining, summer vacation is around the corner, and the grill is out of the garage.

While planning the first summer outing, it is time for patients to review safety precautions for when they are out in the sun. Although the swarm of mosquitoes may be unavoidable, with common sense and preparation all heat-related illnesses are preventable. Here are ways to prevent heat-related illness:

• Drink more fluids during the summer, regardless of activity level; when outdoors, drink 2 to 4 glasses of cold, nonalcoholic fluids every hour
• Do not drink only when thirsty; thirst is the body?s way of saying that it is already dehydrated
• Remain in an air-conditioned environment whenever possible
• Wear lightweight, light-colored, loose-fitting clothing
• Use sunscreen; reapply it often Sunlight contains 2 types of ultraviolet rays?ultraviolet A (UVA) and ultraviolet B (UVB). Although both are harmful, UVB rays are believed to cause sunburns and skin cancer. Even on an overcast day, the UV rays find their way to the ground. The amount of heat and the sun?s brightness are not an indication of the amount of UV exposure. The reflection of UV rays off such surfaces as sand, water, concrete, snow, and white paint adds to the exposure.

By taking simple measures, individuals can limit their exposure to harmful UV rays. For example, limit outdoor activity to the morning and evening hours, if possible. During the summer, initial exposure to the midday sun should not exceed 30 minutes.

Sunscreen plays a crucial role in the prevention of sun-related injuries. Because it takes 30 minutes for sun-screen to bind strongly to the skin, sunscreen should be applied 30 minutes before going outside. Sunscreen also should be reapplied after swimming, or every 1 to 2 hours during extended sun exposure. Sunscreen should not be used on children under 6 months old.

The FDA rates sunscreens according to their sun protection factor (SPF). The higher the SPF is, the greater is the protection against UVB rays. The SPF number estimates how much longer a sunscreen wearer can remain in the sun, compared with an individual who is not wearing sunscreen. For example, if the person normally stays in the sun for 30 minutes without burning, then he or she can stay 15 times longer with an SPF 15 sun-screen. An SPF of 15 usually is recommended. For patients who need greater protection against UVA rays, opaque formulations also are available. These products contain zinc oxide or titanium dioxide.

Although heat-related illnesses can be prevented, they do happen. They can be mildly painful and inconvenient, or they can be deadly. When any of the following 4 conditions occurs, knowing how to treat it is important.

Sunburn

Sunburn is the most common of the summer heat hazards. It is the result of overexposure to UVB rays. Sunburn appears within 24 hours of exposure to the sun and usually peaks within 72 hours. Symptoms range from red, ery-thematous skin that subsequently peels to painful, swollen blisters. Fever, chills, and shock may occur if a large portion of the body is affected.

Treatments for sunburn are limited. Cold compresses, aloe, or topical steroids may relieve symptoms. Steroids never should be applied to open blisters. Oral steroids may be taken to decrease symptoms in extreme cases. Because areas of recently exfoliated skin are extremely sensitive to UVB rays, further exposure to these rays should be avoided until the sunburn subsides.

Heat CrampsHeat cramps are muscle spasms caused by exertion, including work or exercise, during hot and humid weather. These painful contractions, usually of the stomach and leg muscles, are apt to occur after exertion rather than during it. They are caused by a loss of salt and water due to excessive sweating. Treatment of heat cramps includes the following:Resting in a cool placeDrinking a pint of water with 1 teaspoon of salt, or drinking a sports drink Gently stretching the cramped muscle and then massaging it

Heat Exhaustion

Heat exhaustion also is caused by excessive loss of salt and water from exercise or work in hot weather. Symptoms include headache, nausea, vomiting, diarrhea, weakness, irritability, cramps, or diaphoresis. In some cases, the individual may pass out and have a rapid pulse. Treatment of heat exhaustion includes the following:

• Resting in a cool place, preferably air-conditioned
• Drinking cool water with salt or a sports drink
• Taking a cool bath or sponge bath

Changing into lightweight clothing If these steps do not relieve the symptoms within 1 hour or if symptoms worsen, the patient should receive medical attention to avoid heatstroke.

HeatstrokeHeatstroke is a serious medical emergency that results in 4000 deaths annually in the United States. When the body is unable to cool itself, the body temperature rises, causing internal tissue damage. Symptoms include sudden fatigue, seizures, changes in mental status, pinpoint pupils, shallow breathing, and a pulse >160 beats per minute. The patient also will have an elevated body temperature above 104?F. If the body temperature reaches 106?F, the mortality rate may be as high as 76%. Because heatstroke is a medical emergency, immediate treatment is necessary to avoid renal failure, brain damage, or death. Until medical services arrive, the following steps should be taken to rapidly cool the patient:Move the patient to a cool place.Cool the patient by whatever means are possible. (If the patient?s mental status is not affected, immerse the patient in a pool, lake, or bath. Alternatives include wrapping the patient in wet sheets, or placing ice packs wrapped in towels on the person?s wrists and ankles, around the neck, and under the armpits.)If cooling methods cause the patient to shiver, slow down the process. Shivering is the body?s attempt to increase the body?s temperature.Take the patient?s temperature every 10 to 15 minutes to ensure that it does not fall below 101?F. (Cooling the patient too quickly would be too much of a shock to the system.) As seen by the tragic death of Balti-more Orioles pitcher Steve Bechler during spring training, heatstroke is a rapidly progressing and fatal condition. The use of ephedra may have played a role in his death. Any patient buying products containing ephedra should be reminded of its risks, especially during the summer months. Patients should not be deceived, however, into believing that they are immune from this heat-related killer simply because they are not taking ephedra or other herbs and medications. Anyone can succumb to the heat?particularly small children, frail people, and elderly people.

Promoting Sun Safety

As this summer?s first shipments of sunscreen arrive in the pharmacy, retailers must plan displays that will promote sun safety. Just placing sun-screen next to the beach chairs will not prevent summer?s more severe heat-related events. To promote summer health, displays also should contain water, sports drinks, hats with visors or wide brims, and beach umbrellas. Positioning sunscreens with higher SPFs at eye level, and placing tanning oils in less conspicuous locations, will help prevent the accidental use of products that do not protect against the sun.

During the summer, pharmacists can take the opportunity to prevent drug-related problems, too. The return of warm days is the perfect time to remind patients about the photosensitizing effects of their medications. People at risk for heat-related problems, particularly the elderly and small children, should be reminded to avoid exertion and to maintain hydration during the summer months.