Pain-Free Living

Sun Protection for People With Arthritis

by David W. Golann

If you have arthritis, you probably focus on a few tried-and-true management strategies. You may take medicines to treat pain, do exercises to ease stiffness, and use assistive devices to help yourself stay mobile and active. Protecting yourself from the sun probably doesn’t make your to-do list. But for many people with arthritis — either because of the arthritis itself or the drugs they take to treat it — sun protection should be part of a comprehensive self-management plan.

The rays of the sun

The sun emits visible light — the light that allows us to see what’s in front of us — as well as “invisible” ultraviolet light. There are three types of ultraviolet light: ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC). UVC is mostly absorbed in the Earth’s atmosphere, but UVA and UVB come in contact with our skin every day. The results aren’t always pretty. Excessive exposure to UVA can age the skin, and UVB can burn the skin. Both types of ultraviolet light actually alter the DNA of skin cells, increasing the risk of skin cancer down the line. Because of these risks, sun protection is important for everyone. But for some people with arthritis, it is especially important.

Types of arthritis that increase sun sensitivity

Several types of arthritis make people more sensitive to sunlight.

Lupus. Sun sensitivity is a hallmark of all types of lupus, whether the lupus affects many parts of the body (systemic lupus erythematosus, or SLE) or just the skin (discoid lupus erythematosus and subacute lupus erythematosus). People with lupus can have a variety of skin symptoms, including a “butterfly” rash over the bridge of the nose and the upper cheeks; scaly, purplish lesions on the face and neck; and red, circular rashes on the chest, back, and arms. Sun exposure can bring on any of these rashes or make existing rashes worse. In addition, many people with SLE find that all of their symptoms, including joint pain, fatigue, and fever, flare up after exposure to the sun.

People with lupus have to be especially careful about their sun exposure (see below for useful tips on sun protection). They should also be aware that it is not only the sun that emits ultraviolet light. Fluorescent light bulbs and even photocopy machines can too. It is often thought that “covered” fluorescent bulbs — those that have an extra bulb-shaped layer over the typical spiral-shaped tube — emit less ultraviolet light. A recent study, however, has found that this is not necessarily the case. Although only a small percentage of people with lupus are affected by ultraviolet light from sources other than the sun, if your skin is particularly sensitive and you have to be near a fluorescent light for an extended period of time, you should wear sunscreen.

Other types of arthritis. A few other types of arthritis can make people more susceptible to sun-related problems. Scleroderma causes skin to harden and sometimes to become discolored, and people with the condition may find that sun exposure further damages or discolors their skin. People with dermatomyositis, which causes a skin rash in addition to muscle stiffness and soreness, can be sensitive to the sun as well.

Psoriatic arthritis combines the typical skin symptoms of psoriasis — dry, scaly skin — with the joint pain and stiffness of inflammatory arthritis. Psoriatic arthritis is unusual in that UVA rays can actually improve its skin symptoms. In fact, many people with the condition look forward to the sun and humidity of summer because it brings relief from their dry, itchy skin. That said, there is a limit to the amount of sun people with psoriatic arthritis or psoriasis should get. Excessive sun exposure can damage skin cells and make psoriasis worse. A small percentage of people with psoriatic arthritis or psoriasis are very sensitive to the sun and should avoid unnecessary sun exposure.

Drugs that increase sun sensitivity

A great many drugs — including drugs used to treat arthritis — can increase the skin’s sensitivity to the sun. If you take any of these drugs, you may be at a higher risk of skin redness and burning. Among these medicines are nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve), and celecoxib (Celebrex), which are used to reduce pain and inflammation in all types of arthritis. Antimalarial drugs such as chloroquine (Aralen) and hydroxychloroquine (Plaquenil), used to treat lupus and rheumatoid arthritis (RA), can increase sun sensitivity as well. And sulfasalazine (Azulfidine) and methotrexate (Rheumatrex, Trexall), common drugs for the treatment of RA, are well known for causing sun sensitivity.

Other classes of drugs, such as some diuretics (for high blood pressure), sulfonylureas (for diabetes), tricyclic antidepressants, antihistamines, antibiotics, and cardiac drugs can increase sun sensitivity as well. It’s a good idea to check the label of any drug you are taking to see if it has this effect.

Tips for sun protection

If you have lupus or another condition that affects your skin, or if you take one or more drugs that can cause sun sensitivity, you should be especially careful about sun exposure. In general, follow these guidelines: Avoid the midday sun, use sunscreen, and cover up.

Plan your outdoor time. Avoid spending long periods outdoors when the sun is strongest. In most areas of the country, this occurs from April to October, between the hours of 10 AM and 4 PM.

Use sunscreen. Whenever you do go outside, apply sunscreen with a sun protection factor (SPF) of at least 15. (People with lupus or who take drugs that make them sun-sensitive may be advised to use a sunscreen of at least SPF 30.) You should use sunscreen even if it’s cloudy—UVA rays can penetrate the clouds—and in winter too (snow can reflect ultraviolet light).

Remember to apply sunscreen liberally and reapply it every two or three hours you are outdoors. Researchers have found that people often spread a small amount of sunscreen over wide areas of skin, greatly reducing its effectiveness. It’s especially important to reapply sunscreen if you are sweating or swimming. The term “water-resistant” on a sunscreen label generally means the sunscreen will last about 40 minutes in the water; “waterproof” means that it will last for about 80 minutes. The US Food and Drug Administration (FDA) has proposed banning the term “waterproof” from sunscreen labels, but this regulation has not yet taken effect (if it ever will). No sunscreen is completely waterproof. You should also be skeptical of label claims such as “all-day protection” and reapply sunscreen often.

Many sunscreens block only UVB rays. You should seek out a sunscreen that offers both UVA and UVB protection. Labels may indicate that a sunscreen blocks UVA, but they don’t say how well. (The FDA has also proposed regulations to require that sunscreen labels note the level of UVA protection they provide.) Those that advertise “broad-spectrum” protection are not always the best UVA-blockers. A UVA-blocking sunscreen should have at least one of the following ingredients: avobenzone, ecamsule (Mexoryl), titanium dioxide, or zinc oxide. Note that, unlike UVB rays, UVA rays can penetrate glass.

Wear the right clothes. Loose-fitting, long-sleeved shirts are a good idea for people who are sensitive to the sun, as are large- or full-brimmed hats. Your eyes can also be damaged by ultraviolet light, and sunglasses with UVA- and UVB-blocking lenses are recommended.

Treating sunburn

If you get a sunburn, stay out of the sun until it heals. You can apply a cool cloth, hydrocortisone cream, or a moisturizing lotion to the burn, but there is no treatment that will make it go away quickly. If your sun sensitivity is caused by a medicine, you may want to talk with your doctor about switching treatments.

So who needs the sun?

With all the sun’s dangers, you may think it best to spend the rest of your days indoors. Despite the risks of excessive sun exposure, however, everybody needs the sun. One reason is vitamin D. Your body produces vitamin D when sunlight comes in contact with your skin, and vitamin D helps the body use the calcium you take in from food and drink. Calcium helps keep bones strong and prevent the bone-thinning condition osteoporosis. Low levels of vitamin D can be a problem for some people who have minimal exposure to the sun. Many people who live in nursing homes, for example, have been found to be vitamin D–deficient.

Because of these concerns, some researchers have recommended that people get 5–30 minutes of midday sunshine on the face and arms twice a week — without sunscreen. For people with lupus or people who are otherwise sun-sensitive, this recommendation may not be feasible. If you fall into this group, you should discuss your vitamin D levels with your doctor. Vitamin D supplementation may be a good option.

Last Reviewed April 18, 2012

David W. Golann was an Associate Editor at Arthritis Self-Management.

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