Managing Photosensitivity with Arthritis

Photosensitivity is when exposure to sunlight triggers a reaction from your immune system (usually in the form of a rash) and can occur as a result of having inflammatory arthritis. That is why anyone living with this form of arthritis needs to take extra precautions in the sun, especially in summer. Although it feels like one more thing to be mindful about, with a sensible, organised approach to the sun, you should be able to enjoy time outdoors in the summer without the pain and irritation that a sunburn or rash can bring.  

What causes photosensitivity? 

The first main cause of photosensitivity is from the disease itself, however this is usually only applicable in the case of lupus, as opposed to the other types of arthritis. It is believed that this can happen as something in your immune system responds to the changes in your skin as a result of sun exposure. These changes are picked up as something ‘foreign’ and your immune system goes into attack mode, leading to the rash and sensitivity. Lupus is often diagnosed based on a ‘butterfly rash’ that appears on the face and is triggered by the sun and is often one of the first obvious symptoms of the condition. In the case of the other kinds of inflammatory arthritis, such as psoriatic arthritis (PsA) or rheumatoid arthritis (RA), the cause of photosensitivity is usually the medications that you take to manage your inflammatory arthritis.  

Which drugs can trigger photosensitivity? 

Arthritis medications that can cause photosensitivity include prescription disease-modifying antirheumatic drugs (DMARDs) like methotrexate (Maxtrex®, Metoject®, Nordimet®), azathioprine (Imuran®), leflunomide (Arava®), and hydroxychloroquine (Plaquenil®), as well as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), naproxen (Naprosyn®) and celecoxib (Celebrex®).  

 

Skin cancer risk 

In addition to the risks associated with photosensitive reactions, some biologic medications (ie.TNF inhibitors such as Enbrel® and Humira®) may also increase the risk of non-melanoma skin cancers. It is therefore recommended that people with RA who are undergoing these treatments have annual skin checks by a dermatologist. Make sure to discuss this with your healthcare team.  

How serious can photosensitivity be? 

Photosensitive reactions can be either ‘photoallergic’ or ‘phototoxic’. Photoallergic rashes tend to be itchy and inflamed and show up on sun-exposed areas of the body, such as the face, neck, chest and forearms sometimes a few days after sun exposure. The rash may develop into inflamed patches or ‘papules’ that resemble hives. Phototoxic reactions, on the other hand, are more common and resemble a very bad sunburn, sometimes accompanied by blistering and peeling and appear within a few hours of sun exposure. The reaction can lead to swelling, fatigue and even a fever with chills. Regardless of the type of reaction you have, if you have a photosensitivity reaction that is significant, this can also potentially increase your risk of developing skin cancer in the future, which is why vigilance in the sun is so crucial for those living with inflammatory forms of arthritis.  

How can I manage photosensitivity whilst remaining on my medication? 

All drugs have side effects and, unfortunately for some, this includes photosensitivity. However, in most cases, the benefits you receive from taking a drug to help manage your condition will likely outweigh any potential side effects. Most people with inflammatory forms of arthritis can manage their photosensitivity well by simply being vigilant of the sun. The best advice to protect yourself is to follow our top tips below. 

11 Sun-savvy tips 

  1. Avoid direct sunlight wherever possible: Stay in the shade as much as possible and use a UV filtering sun umbrella when outside. Also, don’t forget that sun bounces off reflective surfaces, so even though you’re in the shade, you’ll still be exposed to the sun’s rays meaning taking regular breaks from the sun, by going indoors, is highly advisable.  

  1. Use high factor SPF sunscreen: Of at least 30 SPF or higher, and one that provides broad-spectrum protection against UVA and UVB rays. Be aware that being outdoors in the Irish climate can be just as risky as being abroad, particularly on hot days.  

  1. Make sure to apply enough sunscreen: Experts recommend six full teaspoons of sunscreen to cover the body of an average adult.  

  1. Avoid chemical-laden products: Some photosensitivity can be triggered by perfumed products and even some sunscreens so keep your products as simple and natural as possible.   

  1. Cover up: Wear a wide brimmed hat or baseball cap, invest in a good pair of sunglasses with adequate UV protection and wear sun-protective clothing (t-shirts with UV built-in are ideal, but also long-sleeve shirts will offer protection). The best clothes to wear are those that are tightly woven (ie. little or no space between the threads).  

  1. Avoid artificial light: Many people don’t know that these sources of light can also cause problems for people with photosensitivity – they include fluorescent lighting, photocopiers and tanning beds. 

  1. Apply sunscreen in the morning: Apply your sunscreen ideally 30 minutes before heading outdoors. 

  1. Reapply sunscreen: Aim to reapply every three to four hours as sunscreen stops being protective after that time. Always carry small travel-sized sunscreens with a high factor on you so that you don’t get caught out and you’re able to reapply whenever and wherever you need to.  

  1. Remember to cover all exposed skin: Although sunscreens are helpful, they don’t guarantee protection so covering up is always recommended. Often people forget to cover their neck, forehead, ears, upper chest, arms and hands (and the top of the head for anyone who is balding or thinning on top) with sunscreen.  

  1. Be mindful even on cloudy days: You need to be especially vigilant on hot days, but also cool, windy days will not necessarily prevent your rash from worsening without protection as it is the ultraviolet rays, and not the heat rays, of the sun, which are harmful. 

  1. Protect your skin even behind glass: Most of the sun’s UV rays can penetrate through glass so those rays can still be a problem if you’re in a car on a sunny day or sitting beside a window at a desk.  

 

Remember, if a significant sun reaction does occur, such as sunburn, blistering or if you feel feverish or more fatigued than usual after the sun, checking in with your healthcare team is important. If you are concerned, or have questions about any aspects of living with arthritis, don’t hesitate to call our helpline on 0818 252 846. 

Find out more 

Read more about the different forms of arthritis here. If you are newly diagnosed with arthritis, listen to our podcast on the subject with novelist Sinead Moriarty and IT contractor Sean Lacey, or sign up for one of our Living Well with Arthritis courses.  

 

If lupus is something that you might be concerned about, visit the lupus section of our website which includes a webinar with consultant rheumatologist Dr Laura Durcan who answers all the questions that you may have about the condition.  

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