Because of the ultraviolet radiation it emits, the sun is inherently dangerous to human skin. In fact, the American Academy of Dermatology stipulates that there is no safe way to tan. Tanning is the skin’s natural response to damage from the sun. Additionally, the Environmental Protection Agency proclaims that everybody, regardless of race or ethnicity, is subject to the potential adverse effects of overexposure to the sun. That’s why everyone needs to protect their skin from the sun every day.

How We Burn

When ultraviolet light penetrates the epidermis it stimulates melanin, the substance responsible for skin pigmentation. Up to a point, the melanin absorbs dangerous UV rays before they do serious damage. Melanin increases in response to sun exposure, which is what causes the skin to tan. This is a sign of skin damage, not health. Sunburns develop when the UV exposure is greater than the skin’s natural ability to protect against it.

Sunscreens and Sunblocks

The sun emits two types of ultraviolet (UV) rays that are harmful to human skin. UVA rays penetrate deep into the dermis and lead to wrinkles, age spots and skin cancers. UVB rays are responsible for causing sunburn, cataracts and immune system damage. Melanoma is thought to be associated with severe UVB sunburns that occur before the age of 20.

Sunscreens absorb ultraviolet light so that it doesn’t reach the skin. Look for sunscreens with the active ingredients PABA, benzophenones, cinnamates or salicylates. Sunblocks literally block the UV rays instead of absorbing them. Key active ingredients for sunblock success are titanium oxide and zinc oxide.

There is no sunscreen or sunblock that works 100%. The U.S. Food and Drug Administration regulates the manufacture and promotion of sunscreens. Sunscreens are given a SPF (Sun Protection Factor) number that indicates how long a person can remain in the sun without burning. It is recommended that people use products with a SPF of 15 or greater. Sunscreens are not generally recommended for infants six months old or younger. Infants should be kept in the shade as much as possible and should be dressed in protective clothing to prevent any skin exposure and damage.

There is no such thing as “all-day protection” or “waterproof” sunscreen. No matter what the SPF number, sunscreens need to be re-applied every 2 to 3 hours. Products that claim to be “waterproof” can only protect against sunburn up to 80 minutes in the water. Products labeled “water resistant” can only protect against sunburn up to 40 minutes in the water.

Even in the worst weather, 80% of the sun’s UV rays can pass through the clouds. Additionally, sand reflects 25% of the sun’s UV rays and snow reflects 80% of the sun’s UV rays. That’s why sunscreen needs to be worn every day and in every type of weather and climate. The sun’s intensity is also impacted by altitude (the higher the altitude the greater the sun exposure), time of year (summer months) and location (the closer to the Equator, the greater the sun exposure).

Protecting Yourself From Sun Exposure

• Look for sunscreens that use the term “broad spectrum” because they protect against both UVA and UVB rays.
• Choose a sunscreen with a minimum SPF rating of 15.
• Apply sunscreen 15 to 30 minutes before you head out into the sun to give it time to seep into the skin.
• Apply sunscreens liberally. Use at least one ounce to cover the entire body.
• Use a lip balm with SPF 15 or greater to protect the lips from sun damage.
• Re-apply sunscreen immediately after going into water or sweating.
• Re-apply sunscreen every 2 to 3 hours.
• Use sunscreen every day regardless of the weather.
• Wear sunglasses to protect the eyes from UV rays.
• Wear wide-brimmed hats and protective clothing to limit skin exposure to the sun.
• Stay in the shade whenever possible.
• Avoid using tanning beds.

Treating a Sunburn

If you experience a sunburn, get out of the sun and cover the exposed skin as soon as possible. A sunburn will begin to appear within 4 to 6 hours after getting out of the sun and will fully appear within 12 to 24 hours. Mild burns cause redness and some peeling after a few days. They can be treated with cold compresses on the damaged area, cool baths, moisturizers to prevent dryness and over-the-counter hydrocortisone creams to relieve any pain or itching. It is also important to drink plenty of fluids when you experience any type of sunburn.

More serious burns lead to blisters, which can be painful. It is important not to rupture blisters as this slows down the natural healing process and may lead to infection. You may want to cover blisters with gauze to keep them clean. Stay out of the sun until your skin has fully healed. In the most severe cases, oral steroids may be prescribed to prevent or eliminate infection along with pain-relieving medication.

Lyme disease is a bacterial illness and inflammatory disease that spreads through tick bites. Deer ticks house the spirochete bacterium (Borellia burgdorferi) in their stomachs. When one of these ticks bites the human skin, it may pass the bacteria into the body. These ticks tend to be attracted to creases in the body, so Lyme disease most often appears in armpits, the nape of the neck or the back of knees. It can cause abnormalities in the skin, heart, joints and nervous system.

Lyme disease was first identified in 1975 in Old Lyme, Connecticut. More than 150,000 cases have been reported to the Centers for Disease Control since 1982. Cases have been reported from every state, although it is more commonly seen in the Northeast, Upper Midwest and Pacific Coast. Lyme disease has also been reported in European and Asian countries.

There are three phases to the disease:

Early Localized Phase. During this initial phase, the skin around the bite develops an expanding ring of redness. The ring may have a bull’s eye appearance with a bright red outer ring surrounding clear skin in the center. Most people don’t remember being bitten by a tick. More than one in four patients never gets a rash. The skin redness may be accompanied by fatigue, chills, muscle and joint stiffness, swollen lymph nodes and/or headaches.

Early Disseminated Phase. Weeks to months after the rash disappears, the bacteria spread throughout the body, impacting the joints, heart and nervous system. Symptoms include migrating pain in the joints, neck ache, tingling or numbing of the extremities, enlarged lymph glands, sore throat, abnormal pulse, fever, changes in vision or fatigue.

Late Dissemination Phase. Late in the dissemination of the disease, patients may experience an inflammation of the heart, which can lead to heart failure. Nervous system issues develop, such as paralysis of facial muscles (Bell’s Palsy) and diseases of the peripheral nerves (peripheral neuropathy). It is also common for arthritis and inflammation of the joints to appear, which cause swelling, stiffness and pain.

Lyme disease is diagnosed through a combination of a visual examination and a blood test for Lyme bacteria antibodies. Most cases of Lyme disease are curable using antibiotics, but the longer the delay, the more difficult it is to treat. Your dermatologist may prescribe medications to help alleviate joint stiffening.

The best form of prevention is to avoid tick bites. Use insect repellent containing DEET. Wear long sleeves and pants when outdoors. Tuck the sleeves into gloves and pants into socks to keep your skin covered. After a hike, check the skin and look for any tick bites, especially on children. If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination.

Poison ivy, poison oak and poison sumac are plants that produce an oil (urushiol) that causes an allergic reaction among humans. The inflammation is a reaction to contact with any part of the plant, which leads to burning, itching, redness and blisters. The inflammation is a form of contact dermatitis, an allergic reaction to an allergen that comes into direct contact with the skin. It is not contagious. Poison ivy is more prevalent in the eastern part of the country; poison oak is more prevalent in the southeastern part of the country.

Poison ivy is characterized by red, itchy bumps and blisters that appear in the area that came into contact with the plant. The rash begins one to two days after exposure. The rash first appears in curved lines and will clear up on its own in 14 to 21 days.

Treatment for poison ivy, poison oak and poison sumac is designed to relieve the itching and may include oral antihistamines and cortisone creams (either over-the-counter or prescription). These treatments need to be applied before blisters appear or after the blisters have dried up to be effective. In severe cases, oral steroids, such as prednisone, may be prescribed.

The best form of prevention is to recognize and avoid contact with the plants. This can be difficult because these plants tend to grow around other vegetation. These three poison plants can be distinguished by their classic three-leaf formation. To avoid contact with these plants, wear long sleeves and pants when hiking outdoors and keep to the trails. Tuck the ends of your sleeves into gloves and the bottom of your pants into socks so that no area of skin on your arms or legs is exposed. If you think you have come into contact with a poison plant, wash the area of skin with cool water as quickly as possible to help limit the reaction. Also, wash the clothing you were wearing immediately after exposure.

Pruritus refers to the sensation of itching on the skin. It can be caused by a wide range of skin conditions, including dry skin, infection, fungus, other skin diseases and, rarely, cancer. While anyone can experience pruritus, it is more commonly seen among the elderly, diabetics, people with suppressed immune systems and those with seasonal allergies, like hay fever or eczema. Additionally, there is a type of pruritus, called PUPPP (Pruritic Uticarial Papules & Plaques of Pregnancy) that affects pregnant women.

Treatment for pruritus depends on identifying the underlying cause. Your dermatologist will examine the itchy area and may make a small scrape on any rash to collect tissue for diagnostic testing. Typical treatment involves topical and/or oral steroids and antihistamines to help relieve the itch. To avoid pruritus, make sure to follow healthy skin care procedures.

There are literally hundreds of different kinds of lumps, bumps and cysts associated with the skin. Fortunately, the vast majority of these are harmless and painless. The chart below provides a guide for some of the most common forms of skin lumps, bumps and cysts.

Dermatofibromas

Characteristics

• Red, brown or purple growth; generally benign
• Usually found on arms and legs
• Feels like a hard lump
• Can be itchy, tender to the touch and sometimes painful

Treatment

• Usually does not require treatment
• Most common removal by surgical excision or cryotherapy (freezing it off with liquid nitrogen)

Epidermoid Cysts (Sebaceous Cysts)

Characteristics

• Round small bumps, usually white or yellow
• Forms from blocked oil glands in the skin
• Most commonly appear on the face, back, neck, trunk and genitals
• Usually benign; occasionally leads to basal or squamous cell skin cancers
• If infected, will become red and tender
• Can produce a thick yellow, cheese-like discharge when squeezed

Treatment

• Antibiotics might be prescribed if there is an underlying infection
• Dermatologist removes the discharge and the sac (capsule) that make up the walls of the cyst to prevent recurrence
• Laser surgery may be used for sensitive areas of the skin, like the face

Folliculitis

Characteristics

• Red pimples around areas having hair
• Inflammation of the hair follicles
• Caused by infection or chemical or physical irritation (e.g., shaving, fabrics)
• Higher incidence among people with diabetes, the obese or those with compromised immune systems

Treatment

• Topical antibiotics
• Oral antibiotics
• Antifungal medications
• Eliminating the cause

Keratoacanthoma

Characteristics

• Red, dome-shaped, thick bumps with craters in the center
• Abnormal growth of hair cells
• Triggered by minor skin injury such as a cut or bug bite
• Ultraviolet radiation from sun exposure is the most common risk factor

Treatment

• Cryotherapy (freezing off the bump with liquid nitrogen
• Curettage (surgically cutting out or scraping off)

Keratosis Pilaris

Characteristics

• Small, rough white or red bumps that neither itch nor hurt
• Usually worse during winter months or when there is low humidity and the skin gets dry

Treatment

• Usually does not require treatment
• In most cases disappears on its own by age 30
• Intensive moisturizing is the first line of treatment
• For more difficult cases, use of medicated creams with urea or alpha-hydroxy acids

Lipomas

Characteristics

• Soft fatty tissue tumors or nodules below the skin’s surface
• Usually slow growing and benign
• Appear most commonly on the trunk, shoulders and neck
• May be single or multiple
• Usually painless unless putting pressure on a nerve

Treatment

• Usually does not require treatment unless it is compressing on the surrounding tissue
• Easy to remove via excision

Neurofibromas

Characteristics

• Soft fleshy growths under the skin
• Slow growing and generally benign and painless
• Pain may indicate a need for medical attention
• May experience an electrical shock at the touch

Treatment

• Usually does not require treatment, particularly if it does not cause any symptoms
• If it affects a nerve, it may be removed surgically

Skin Cysts

Characteristics

• Closed pockets of tissue that can be filled with fluid or pus
• Can appear anywhere on the skin
• Smooth to the touch; feels like a pea underneath the surface
• Slow growing and generally is painless and benign
• Only needs attention if it becomes infected or inflamed

Treatment

• Usually does not require treatment; often disappears on its own
• May need to be drained by a physician
• Inflamed cysts respond to an injection of cortisone, which causes it to shrivel