Aug 4, 2022

TRANSCRIPT

Dr. Tarbox: Hello and welcome to "Skincast," the podcast for people who want to learn to take the very best care of the skin they're in. My name is Michelle Tarbox, and I'm an academic dermatologist at Texas Tech University of Health Sciences Center in beautiful, sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hi, everybody. This is Dr. Luke Johnson. I'm a pediatric dermatologist and general dermatologist with the University of Utah.

Dr. Tarbox: So I have to say one thing to you right now, Luke. Woo, it is hot. It is hot, and it is sunny. How about where you are?

Dr. Johnson: Oh, yeah, it was 104 degrees the other day.

Dr. Tarbox: So I thought we might talk about the unique challenges our skin face in the summer months and some things that we can do about that. Now, one of the things I like to discuss with my patients, when we're talking about summer skincare, is that we need to think about the huge job our skin has to do over the course of a long, hot summer. It has to keep us cool. It has to protect us from the environment, which includes the sun that can come to us from the outdoor exposure, the insects that we're increasingly exposed to when we're outdoors, and the plants we might come into contact as we venture out into nature. So our skin has a huge job to do. And in general, for your summer skin, you want to cleanse it gently. You want to moisturize it to restore moisture after the sun has stripped that away or the heat and the sweat has caused irritation over the course of the day.

Many people have like a summer regimen for their skin. I think simpler is often better. And using products that are hypoallergenic and gentle is generally a win-win situation, of course with a good and robust sun protection regimen, which we've discussed previously on the podcast.

And then I also want to talk about things people come in contact with uniquely in the summer. So I'm going to kind of categorize those into three things. And one will be a standalone episode by itself, because there's just so dadgum many of them. But the things we can come into contact in the summer are the three P's — plants, poisoning, which can be the sun or other chemicals, and parasites and other bugs.

So plants, we'll talk about first toxic plants, and, of course, the toxic plant that comes first to your mind is going to be poison ivy. And we talked about poison ivy a little bit before. But some things we haven't discussed is that it's actually becoming more populous because of climate change. So there are more favorable growth environments for this plant, and it's found everywhere in the United States, except for Alaska and Hawaii. Of course, it's more common in eastern and Midwestern states, and less common outside the United States, but it's found on every country, in every continent. And sprigs of poison ivy may also be present around the base of nursery plants.

So even if you live in an area that traditionally doesn't have a whole lot of poison ivy, you may still be exposed to it if you buy, say, a tree from the nursery and it came from a part of the country where it's more endemic. So exposure is relatively ubiquitous. But it also may be becoming more dangerous. So poison ivy is also potentially creating a greater concentration of the toxic oil that we call urushiol that's in the leaves that can cause the rash. So patients might have a more significant rash than they've previously experienced to poison ivy, and people who previously kind of flew under the radar might also develop symptoms.

About 80% of people will get a rash when they're exposed to poison ivy, and about 20% of people are lucky and just don't make that rash. But those numbers may change as the concentration of this toxic chemical can increase.

So leaves of three, it's better to let it be. Now, Luke, I know you've probably seen this more than I have. What does the rash of poison ivy look like, and what are the symptoms?

Dr. Johnson: Well, it actually looks a fair amount like eczema, because it's technically an allergic contact dermatitis. But it's usually just in one spot, the spot that touched against the poison ivy. And it can be a really vigorous response. So you can get blisters, or you can get little tiny, tiny baby blisters, which we call vesicles. And then you can have different reactions too if you do something like walk through a whole patch of poison ivy, or most of your body is affected, or there are reports of people who accidentally burn the poison ivy and then the smoke can cause major issues. But you want to look for a localized area that was probably brushing against the plant for some reason, especially if there's blisters in it, usually super itchy.

Also, Michelle, how come we always hear about the bad things that are getting more populous with climate change? It's always poison ivy and like wood beetles and ticks and things. How come it's not like parrots and cute animals and stuff that are expanding their territory?

Dr. Tarbox: I mean, you know, there might be some cute things that are having an easier time living in, you know, warmer climes. I'm not sure. I think we tend to notice the negative things more, and they get more attention. But, you know, it's possible that there are certain populations of daisies or butterflies or something that increase in general. But it seems like the hardier, more malicious plants always seem to benefit from adverse circumstances. And maybe that has to do with the character of the plants. They're just . . . you know, they've got grit and determination or something like that.

Dr. Johnson: Fair enough.

Dr. Tarbox: So how do you . . .

Dr. Johnson: Well, if you do get poison ivy, you might want to treat it. So our treatments are usually topical steroids. So topical means something you put on the skin. So if you don't have easy access to a doctor or somebody who can prescribe you one, then over-the-counter hydrocortisone will work all right. The ointment formulations tend to work better than the creams. So ointment is kind of gloopy, like Vaseline. So you might put that on your skin a couple of times a day. And then, if that's not cutting it, think you need something stronger, then get in touch with somebody like us.

Dr. Tarbox: Absolutely. And I think that, you know, if you've got symptoms you can't manage, sometimes patients will try unusual home remedies and things like that. It's much better to seek the advice of a medical professional early on in those circumstances.

So moving away from the plants, let's talk about some poisonings, specifically sun poisoning. So we all are probably familiar with a sunburn, where we get overexposure to UV radiation, and we can get redness or tenderness or itching. Usually lasts somewhere between 6 to 48 hours. It can cause permanent damage. It is a big deal because it can increase your risk of skin cancer. But in the acute period, it's pretty easy to manage. So you can put a little cool water or a cold compress. You can moisturize the skin using a non-petroleum or oil-based lotion. You can also take pain relievers, such as naproxen. You can take ibuprofen. Some people benefit from those things.

Sun poisoning is different. So sun poisoning is kind of an extreme sunburn that is bad enough to cause systemic symptoms. So besides the external effects of a sunburn, you can also have skin blistering. You can have headaches, nausea, dehydration, and dizziness, and it can actually last quite a long time. So unlike a sunburn, which has got a bit of a limited lifetime, sun poisoning can last up to a week, depending on the level of exposure. And so these might be treated with cold compresses, oral steroids, topical antibiotics, or lotions, depending on the severity of skin involvement. Have you ever had . . .

Dr. Johnson: It sounds miserable.

Dr. Tarbox: Oh, God, it's awful. Have you ever had a patient with sun poisoning?

Dr. Johnson: I'm honestly not sure I've ever even heard about sun poisoning before. So here, I'm learning something too.

Dr. Tarbox: Growing up in sunny Lubbock, Texas, I woke up to a personal story of sun poisoning. So my twin sister and I were at a place called Texas Water Rampage, which has a wave pool. As you might imagine, a wave pool is extremely efficient at washing sunscreen off of yourself. And when you're an enthusiastic teenager, who's having a good time, you maybe don't notice so well that you are getting severely sunburned. So both of us actually ended up with sun poisoning. So we had yellow blisters all over our poor little shoulders. I'm still waiting for the aftermath of that to show up. And we both had headaches, and nausea, and dehydration, and dizziness.

I remember it very well, because we shared a room growing up. And so we spent about three days in the summer just laying on our beds, our twin beds that were like on opposite side of the room, sort of moaning at each other across the room from the sun poisoning.

So definitely something that can happen and something that you want to avoid. And the way you avoid that is protecting your skin from the sun, making sure to stay hydrated, and using reasonable breaks from sun exposure. I like to tell my patients I don't want you in the direct sun longer than one to two hours at a time if possible and shorter if possible.

Dr. Johnson: So people often put aloe on sunburn, Michelle. Does that makes any sense?

Dr. Tarbox: That's a great question. There's some benefits to topical aloe vera straight from the plant, so long as you're not contact-allergic to that product. It does have some vitamins in it that are antioxidants, and it has some demulcent properties where it can actually help to moisturize injured and desiccated tissues.

It does get more complicated when it's a prepared aloe vera product. The proportion of aloe vera, actually, in the product varies greatly. A lot of them contain alcohol and are in gel formulation, which might actually cause more damage by stinging or by inadvertently dehydrating the skin. When you apply an alcohol-containing gel to the skin, it feels cooler temporarily because you have evaporative cooling occurring. And certainly, removing the heat from a burn is a good idea, but the alcohol potentially could cause more dehydration of the epidermis as well. So if you are an aloe vera, like, fan, I advocate straight from the plant instead of out of a bottle.

Dr. Johnson: Well, I'm not going to carry plants around with me on my cruise. Should I just be putting hydrocortisone on my sunburns?

Dr. Tarbox: I think hydrocortisone is more reliable and easier to obtain than some aloe vera preparations. But, you know, certainly you can look into being prepared ahead of time with something less complex, perhaps a prepared aloe vera that only has a few ingredients and is relatively simple and hypoallergenic.

Now, heat rash is also something that can occur, which is different than sunburn or sun poisoning. And we have seen an obscene amount of this in the past week, where our temperatures have climbed over 108 degrees.

So because of the hot and humid weather, here in Lubbock, Texas, not so humid, the skin's pores can become clogged with sweat. And so that actually causes trapping of the perspiration in the epidermis, and it makes a heat rash. This happens often in high friction areas, like underarms, elbow creases, inner thighs. I see it all the time under the breasts. The heat kind of gets also trapped in those areas. The heat rash can be treated with calamine lotion, straight aloe vera. You can also potentially use topical steroids for that. But heat rash is also something that's relatively frequent.

Do you see heat rash much where you're practicing?

Dr. Johnson: Sure. The medical term is miliaria. And it's common in little babies, because their sweat pores are such tiny, tiny little baby sweat pores, that they're easily just get blocked up. So it can happen in adults too, but it's more common, I think, if you're in a hot environment, if you're a little baby, and your sweat glands aren't working right anyway. Also, sometimes people over-swaddle or over-blanket their babies, and then they can get these little heat rashes.

Dr. Tarbox: I think that, you know, the miliaria can be in different kinds of forms. It could be miliaria pustulosa and make pustules. It can be miliaria rubra, which is red bumps around those inflamed hair follicles.

And we also can have that complicated by yeast overgrowth, which we see a lot of as well in practice, especially in skin folds, especially the groin and under the breasts. And when we have an overgrowth or a bloom of yeast, that can cause inflammation because our immune system is not fond of the yeast. It's not fond of the yeast because if the yeast gets in our blood vessels, it can be very serious for us. So our immune system is really serious about yeast. We get a lot of inflammation and erythema, which correlates to a lot of pain. It also, of course, can have that characteristic yeasty smell.

So if you have what you think is a heat rash and it smells like you're making bread, you may want to look for some anti-yeast treatments, which can be available over the counter. Products such as Nizoral shampoo can be used in the shower, or ciclopirox-containing creams can be used as a topical treatment.

Dr. Johnson: How is sun poisoning different than heat exhaustion?

Dr. Tarbox: That's a great question. You know, sun poisoning is kind of a little bit more complicated than heat exhaustion. They both overlap in a lot of ways, but there are a few things that can differentiate between the two. And I think that it really kind of is based off of the difference in the sort of skin directedness of sun poisoning.

Heat exhaustion is a more systemic presentation. The patients sweat a lot, they become very dehydrated, and they become incapable of regulating their temperature. So these patients can become lightheaded. They can actually have an increased heart rate, because their heart is basically trying to circulate the blood through their skin fast enough to dissipate enough heat to try to regulate the temperature. Thirst would typically be increased. Patients can also have even weakness with this.

This is a very important thing to look at sort of hydrating the person. The way I differentiate them is sun poisoning is like a sunburn that gets so bad that the inflammation it causes makes you sick. Heat exhaustion is a person who has lost so much water that their body is having trouble regulating its temperature, and the side effects are coming from that. Does that make sense?

Dr. Johnson: And sun poisoning is more related to actual sun exposure, whereas you could get heat exhaustion, or I suppose heat stroke, if you're not in the sun, if you're like in a hot garage or something.

Dr. Tarbox: That's true. Yeah. Sun poisoning requires the presence of actual direct sun exposure, whereas heat exhaustion and heatstroke can occur in the shade. And a heatstroke can have temperatures up to 104 or higher. The patients often have a dry, hot skin. They're confused, agitated, and may even have seizures or loss of consciousness.

Dr. Johnson: Stay in the shade, wear big hats, and drink a ton of water. I think this water thing is more important than I realized. I drink a lot of water, and I feel like I drink enough. But I feel like I actually should be drinking like twice as much water as I do, or even more than that, if I'm going to be out in the heat.

Dr. Tarbox: Especially with these extremely hot temperatures that people are experiencing, we're just not adapted for this as well. So I think that making sure that you're staying extremely well-hydrated. You want to make sure you have plenty of water available to you. Using those sun smarts, avoiding the sun from the peak hours, which is 10 a.m. to 2 p.m., and seeking shade as often as possible can help people continue to have fun in the sun, even in these hot, hot days.

Dr. Johnson: And don't push yourself. If you're feeling like it's too hot and it's time for a break, you don't need to prove to anybody that you can muscle it out for another 20 minutes in the sun. Just go sit down for a second.

Dr. Tarbox: I think that's great advice in general in life, Luke.

Dr. Johnson: Well, have a fun, healthy, and safe summer, everybody. Thanks so much for joining us today. Thanks to the University of Utah for supporting the podcast, and thanks to Texas Tech for lending us Michelle. And if you would like to learn more about dermatology, you can do so on our other podcast.

Dr. Tarbox: Our other podcast is called the "Dermasphere" podcast. It is about an hour long, and it is the podcast by dermatologists for dermatologists and the dermatologically curious. It can be found anywhere you listen to your podcasts. But also, we have our own social media pages under Dermasphere Podcast, and dermaspherepodcast.com is our website.

Dr. Johnson: All right, everybody. Stay cool.