Outdoor Exposure: High Risk for Skin Issues

Exposure to plants, insects, pollution, and the sun increases the risk for skin damage.

From contact dermatitis due to poisonous plants, to insect bites and stings, to air pollution and sun exposure, outdoor exposure can cause serious skin damage. This article covers important information that you can share with your patients as they begin to spend more time outdoors this spring and summer.

Contact Dermatitis

At least 1 poisonous plant species can be found in every state in the contiguous United States.¹ The most common of these plants are poison ivy, poison oak, and poison sumac. When the leaves of these plants are bruised, damaged, processed, or burned, they release an oil called urushiol that causes contact dermatitis in sensitive individuals.^2,3 This oil can come into contact with the skin by either direct contact with the plant or indirect contact with items that have urushiol on them, such as animals, tools, toys, and clothing.^1,2

The best defense against plant-induced contact dermatitis is to avoid the plants altogether. Therefore, individuals should become familiar with their local poisonous plant species and be able to identify them in all 4 seasons.² Protective clothing, such as long-sleeved shirts, long pants, boots, nonrubber gloves, and hats, may also help protect the skin. Skin creams may offer some protection before contact, as well¹: Ivy Block, quaternium-18 bentonite—containing creams, and Stokoguard cream (only available through industrial suppliers) are effective skin barriers.^1,2,4 Because urushiol can remain active for up to 5 years on exposed objects,¹ any exposed tools or toys should be washed with soap and water or rubbing alcohol and all exposed clothing should be washed or dry cleaned.

First aid for contact dermatitis includes cleansing the exposed skin with rubbing alcohol or washing with a degreasing soap and water and scrubbing under fingernails with a nail brush. Additional helpful suggestions include applying wet compresses and hydrocortisone cream or calamine lotion to exposed areas, soaking in an oatmeal bath, and taking oral antihistamines. In severe cases or if there is face or genital exposure, patients should seek medical attention.¹

Insect Bites and Stings

Bees and fire ants and mosquitoes, oh my! Nature is full of fascinating characters. Unfortunately, these characters can have a negative impact on our skin, which can range from mild discomfort or pain to serious allergic reactions.⁵

Symptoms of insect bites and stings depend on the type of insect, but generally include pain, itching, swelling, numbness, redness, burning, and tingling at the bite site.6 People allergic to the venom may even experience an anaphylactic reaction. If trouble breathing, swelling of the face or mouth, or throat tightness occurs, call 911 immediately.⁶

Prevention of insect bites and stings includes wearing light, solid-color (not bright), and smooth clothing that covers as much of the body as possible; not using perfumes/colognes, perfumed soaps, shampoos, deodorants, and anything bananascented; avoiding rapid, jerky movements around hives, nests, or the insects themselves; and applying appropriate insect repellents according to package labeling.^5-7 Some insect repellents, however, are not recommended for use on younger children, so read usage instructions carefully.

First aid for mild reactions includes removing the stinger (if appropriate), washing the area with soap and water, and applying a cool compress.⁸ Creams that help control the pain from a sting, such as hydrocortisone, pramoxine, and lidocaine; products with calming ingredients such as colloidal oatmeal, calamine, and baking soda; and OTC pain relievers and antihistamines may also help.

Air Pollution

Air pollution can be natural (fires, soil erosion, and volcanic particulates) or manufactured (vehicle emissions and manufacturing debris).⁹ As these particulates float through the air, they are changed to free radicals by the ultraviolet rays of the sun and other sources.¹⁰ These free radicals attack cells and damage DNA, thereby stripping skin of moisture. This results in skin discoloration, fine lines, and wrinkles.¹¹ These effects are most prominent on the face, neck, and hands.

While as a country we are striving to improve air quality, there is not much we can do to limit our exposure to air pollution. We can, however, take steps to protect our skin from its effects. Daily washing to remove pollutants from the face, neck, and hands is important. Exfoliating twice each week will help remove any lingering debris and open the pores, and a daily moisturizer will help rehydrate the skin. Rehydrating from the inside by drinking plenty of water and supplementing the diet with vitamins and antioxidants can also help protect the skin. See the Table for a list of skinprotecting supplements.¹²

Sun Exposure

Sunlight that reaches the earth has ultraviolet A (UVA) and ultraviolet B (UVB) rays, each an invisible type of radiation that can penetrate skin cells and cause damage ranging from premature aging to serious skin cancer.^13,14 UVA rays, which are more prevalent than UVB rays, can penetrate deep into skin layers, causing long-term damage and increasing the risk of skin cancer.¹⁴ UVB rays help us produce vitamin D in the skin, but are responsible for sunburn and tanning and can cause skin cancer and cataracts.¹³

Skin cancer is the most widespread form of cancer in the United States. The 2 most common forms, basal cell and squamous cell carcinomas, although curable, are not tracked by central cancer registries.¹⁵ Melanoma is the third most common skin cancer and can be deadly.¹⁴ In the United States in 2011, 65,647 people were diagnosed with skin melanomas, and 9128 people died of them.¹⁵

Sunburn occurs when the amount of UV light exposure exceeds the body’s ability to protect its skin. Typical symptoms include painful, red skin; severe symptoms may include swelling, blisters, fever, chills, and weakness. In rare cases, severe sunburn can lead to shock.¹⁶ Treatment of sunburn should include a cold compress to affected areas, aspirin or acetaminophen to relieve pain and inflammation, and a cooling gel, cream, or ointment containing aloe vera.¹⁶ Topical anesthetics are also available, but should only be used on intact skin. Patients with severe sunburn should seek medical attention.

For information on the prevention of sunburn, please see the OTC Focus, “Protecting Skin from Sun Damage,” in this issue.

Conclusion

Since the summer is quickly approaching, knowing how to protect yourself and your patients from outdoor elements is essential. A few quick and easy steps can keep your skin healthy and protected.

Dr. Kenny earned her doctoral degree from the University of Colorado Health Sciences Center. She has 20-plus years of experience as a community pharmacist and is a clinical medical writer based out of Colorado Springs, Colorado.

References

• Poisonous plants. Centers for Disease Control and Prevention website. www.cdc.gov/niosh/topics/plants/default.html. Updated July 21, 2014. Accessed February 28, 2015.
• Guin JD. Treatment of toxicodendron dermatitis (poison ivy and poison oak). Skin Therapy Letter website. www.skintherapyletter.com/2001/6.7/2.html. Accessed February 27, 2015.
• Evans FJ, Schmidt RJ. Plants and plant products that induce contact dermatitis. Planta Med. 1980;38(4):289-316.
• Marks JG Jr, Fowler JF Jr, Sheretz EF, Rietschel RL. Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite. J Am Acad Dermatol. 1995;33(2.1):212-216.
• Insects and scorpions. Center for Disease Control and Prevention website. www.cdc.gov/niosh/topics/insects/. Updated February 24, 1012. Accessed February 28, 2015.
• Insect bites and stings. US National Library of Medicine website. www.nlm.nih.gov/medlineplus/ency/article/000033.htm. Updated January 13, 2014. Accessed February 28, 2015.
• Avoid bug bites. Centers for Disease Control and Prevention website. wwwnc.cdc.gov/travel/page/avoid-bug-bites. Accessed February 28, 2015.
• Insect bites and stings: first aid. Mayo Clinic website. www.mayoclinic.org/first-aid/first-aid-insect-bites/basics/art-20056593. Updated February 20, 2015. Accessed February 28, 2015.
• Air. Agency for Toxic Substances and Disease Registry website. www.atsdr.cdc.gov/general/theair.pdf. Accessed March 16, 2015.
• Emerit I. Free radicals and aging of the skin. EXS. 1192;62:328-341.
• Pollution, stress take toll on skin aging. Dermatology Times website. http://dermatologytimes.modernmedicine.com/dermatology-times/content/tags/anti-aging/pollution-stress-take-toll-skin-aging. Accessed March 15, 2015.
• Supplements for healthy skin. WebMD website. www.webmd.com/beauty/skin/skin-care-guide. Accessed March 16, 2015.
• Ultraviolet rays from the sun - topic overview. WebMD website. www.webmd.com/skin-problems-and-treatments/tc/ultraviolet-rays-from-the-sun-topic-overview. Accessed March 16, 2015.
• What is skin cancer? Centers for Disease Control and Prevention website. www.cdc.gov/cancer/skin/basic_info/what-is-skin-cancer.htm. Updated February 19, 2014. Accessed February 28, 2015.
• Skin Cancer Statistics. Centers for Disease Control and Prevention website. www.cdc.gov/cancer/skin/statistics/index.htm. Accessed March 16, 2015.
• Sunburn. WebMD website. www.webmd.com/skin-problems-and-treatments/guide/sunburn. Accessed March 17, 2015.