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PHARMACY

Burns, Bugs and Boo-Boos
Treating and preventing summer hazards

Every year it’s the same. I can see them coming from across the pharmacy. Lobster-red faces flooding toward me, scratching themselves in strange places, seeking relief from the stinging, burning, hurting and itching. Has there been some sort of big chemical accident? No, just the first really sunny, warm weather of the year. As sun-starved Canadians, we are only too glad to trade in our sweaters and jackets for tank tops and shorts. Unfortunately, in our enthusiastic shedding of winter clothes, we often forget that summer weather also brings summer hazards such as sunburn and insect bites. Fortunately, with a little preparation, these hazards can usually be avoided.

Don’t feel the burn

Sun exposure can lead to premature aging of the skin and skin cancer such as melanoma and squamous cell cancer. Sunburn can hasten these effects. If possible, avoid being in the sun from 10 a.m. to 3 p.m. as these are peak burning hours. Wear a hat and cover up. Stay in the shade, bearing in mind that sunlight can reflect from a number of sources, such as sand, water and even snow. Last but not least, wear sunscreen!

UVA, UVB, SPF – What does it all mean?

You've decided to plan ahead and purchase some sunscreen before you venture out into the great outdoors. You've found the pharmacy sunscreen aisle but are confronted with all sorts of abbreviations. What do they all mean?

Sunlight contains two kinds of harmful rays – UVA (ultraviolet A radiation) and UVB (ultraviolet B radiation). UVA easily penetrates the skin layer called the dermis, and can cause premature aging, skin wrinkles, sunburns and some skin cancers. UVA is also responsible for most skin reactions that can happen when you take certain medications and go out in the sun. These are known as photosensitivity reactions. UVB causes sunburn, and can damage and alter DNA (the 'command centre') in skin cells, contributing to some skin cancers. Both types of UV radiation may contribute to eye damage and suppression of your immune system.

You want a sunscreen that protects from both UVA and UVB rays and has a SPF of at least 30. Oops, another abbreviation! SPF stands for sun protection factor. An SPF of 30 means that it takes 30 times longer for your skin to burn than it would without the sunscreen. A product with an SPF of 30 will block about 97 per cent of UVB radiation. However, bear in mind that these products were tested in ideal lab conditions and do not factor in sweating, swimming and other individual circumstances. Also, even products with very high SPFs do not block 100 per cent of UV rays. Sunscreens with Mexoryl™ or Parsol™, and products containing homosalate, titanium dioxide and zinc oxide may also be good choices.

Applying sunscreen

Put on sunscreen at least 15 to 30 minutes before going outdoors. This gives the lotion enough time to bond with the skin. For most adults, it takes about 30 millilitres (one ounce) of lotion to sufficiently cover the body. If you have chosen a spray-on sunscreen, be sure to cover exposed skin completely with the spray and rub it in. Avoid spraying your face and eyes. Instead, spray the product into your hands and rub onto your face. Don't forget your lips, nose and tips of the ears! Reapply sunscreen after heavy sweating, swimming, and towel-drying, even if it is waterproof. If you have a history of skin reactions to sunscreens or other skin products, patch test the product. Put a small amount on the inside of your arm and leave it for a day. If you've had no reaction by the following day, it should be safe to apply to the rest of your body.

Specially made sun-protective clothing is also now available. A shirt with a UPF (UV protection factor) rating of 20 means that only 1/20th of the sun's UV rays can reach the skin through the fabric. Regular bright or dark-coloured clothing reflects more UV rays than light-coloured clothing. Tightly-woven fabrics provide more of a barrier between you and the sun than do loosely-woven, thinner fabrics. Hats with broad brims help block the sun on your face and head. It is also very important to protect your eyes and your children's eyes with UV protective sunglasses. Exposing your eyes to UV radiation may contribute to future cataract formation and blindness. Ask your eye doctor if your contact lenses are providing UV protection – many brands of contact lenses do!

What about the kids?

You know putting sunscreen on your kids is important, but getting a squirming two-year-old to hold still can sometimes make you want to just stay inside. However, it is worth persisting. Remember all of the future problems you may be preventing for your child.

• Make a game of it. I got your nose, now I'm going to tickle your tummy...
• Try the spray-on type. It is often easier to reach flailing legs and wriggling torsos with spray. Just make sure to avoid getting the spray in their faces (and yours!).
• Make it a routine. Children love their routines.
• Be a good example. Apply sunscreen to yourself first.
• Make it a rule. No going outside until the sunscreen goes on.

In general, children six months and up can wear the same sunscreens as adults. Just be sure to patch test first. Parents often ask about the difference between sunscreens labelled for kids and regular sunscreen. The answer is usually, not much! There is usually no difference in ingredients between regular and 'children's' sunscreen within the same brand, In fact, one manufacturer's representative said the only difference between the adult and children's sunscreen in her line of products was the packaging. It is usually not necessary to buy separate products for adults and children. For infants under six months of age, just keep them out of the sun or cover them up with protective clothing and a broad-brimmed hat to avoid the sun's rays. At this age, their skin is very sensitive and it is best to avoid sunscreen products altogether.

What if you’re already a lobster?

Let's go back to all those lobster-red faces coming into the pharmacy. What do you do if you're already burned? In general, most sunburns can be treated like a first-degree burn. Aloe vera gel is gentle, cooling, moisturizing and feels very nice on the skin. Another way to relieve the burning is to have a cool (not cold) bath or to apply cool, wet compresses. Over-the-counter pain relievers such as ASA, acetaminophen (Tylenol™), ibuprofen (Advil™ or Motrin™), or naproxen sodium (Aleve™) will also provide some relief. Just be sure not to give any ASA products to children, as there is always the danger of Reye's Syndrome. Try to drink extra fluids to help increase your hydration. Avoid alcohol as it can be very dehydrating. (This may put a damper on the after-sun barbecue party, but better safe than sorry.) Pain-killing sprays or lotions for the skin that contain benzocaine or lidocaine are also best avoided. They have the potential to cause allergic reactions or increase skin sensitivity. If the sunburn is severe, or if a child under one year has been sunburned, contact a doctor as soon as possible. Scarring, dehydration, shock, sunstroke or infection may occur if severe sunburn is left untreated.

How about those bugs?

Nothing can ruin a beautiful, warm day faster than pesky insects. Mosquitoes, fleas, ticks, biting flies – they all seem to be on a mission to bug us. Using insect repellents containing DEET (diethyltoluamide) can be effective in discouraging most of these nasty little creatures. DEET can be absorbed into the skin; however, products containing less than 75 per cent of DEET are considered safe for adults. For children over six months, 10 to 20 per cent DEET is considered safe. No insect repellent should ever be used on an infant less than six months of age.

When applying the repellent, you want to cover all exposed skin, but be sure to avoid eyes, lips and any open wounds. One application will last anywhere from two to eight hours, depending on the product. Check the product package for re-application recommendations. Avoid using combination sunscreen/insect repellent products because sunscreens generally need to be put on in greater quantity and more frequently than repellents. If you do need to use both products, apply sunscreen first. Rub it in well, then apply the repellent. Do not apply repellent to children's hands if they tend to put them in their mouths. It is better to use lotions, liquids or pre-moistened towelettes on children rather than sprays. Children may inhale the spray, which may increase the risk of toxic effects. Sprays may be used on clothing, but only on natural fabrics such as cotton. DEET may break down synthetic fabrics and plastics. Always keep insect repellents out of reach of children. If your child eats some repellent, seek medical help immediately since this can be fatal.

If you prefer not to use DEET products, you can do other things to avoid being bugged and bitten. Wear long pants and shirts, avoid brightly coloured clothes, tuck your pant legs into socks and shirts into pants, and don't wear perfume. For children under six months, the best prevention is to cover all exposed skin with clothing and use a mosquito net over the stroller, playpen, or tent. Some people have used oil of citronella or Avon's Skin-So-Soft™ bath oil as insect repellents. Unfortunately, neither is clinically proven to repel bugs. Nor are they recommended for children. Others claim that taking extra vitamin B1 (thiamine) will repel bugs, but this has not been proven effective either.

Travel south of the United States or to other 'exotic' destinations may require special protection. Ask for advice from a traveller's health clinic before you go and, if bitten, see your doctor on your return.

You've got that itchy feeling

So the bugs got you. Now what? Lotions containing calamine or oatmeal can be very helpful in reducing itch and are safe for children as well as adults. Apply the lotion frequently to the bites. Hydrocortisone cream of 0.5 per cent can also help reduce redness, swelling and itching, but should be applied sparingly three to four times a day at most. Do not apply any of these products to broken skin. Some people find oatmeal or baking soda baths very soothing. Try not to scratch – easier said than done! The problem is that scratching may break the skin, allowing bacteria into the area. You may end up with a skin infection. If you have many bites and are very itchy, an oral antihistamine such as diphenhydramine (Benadryl™) or cetirizine (Reactine™) can also help. Avoid antihistamine and anesthetic creams and lotions that are put on the skin, since these can irritate it further.

Scrapes, bumps & boo-boos

Summer weather also brings more outdoor activities, which in turn bring more cuts and scrapes. First, be careful and use common sense. Don't be like the businessman who came into the pharmacy with a bloody elbow. He sheepishly said he had fallen trying to imitate his teenaged son's skateboard tricks while wearing his business suit and no protective gear. Use appropriate safety equipment and clothing for the activity.

For minor cuts and scrapes, first clean the wound with water to remove any dirt. Then, gently pat the area dry with a clean washcloth or gauze. Baby shampoo may also be used as a cleansing agent. Avoid antiseptics such as rubbing alcohol, iodine, and hydrogen peroxide as they can be irritating and can actually reduce the speed of healing. Here is a good rule of thumb for wound cleansing: if you wouldn't put that cleanser in your eye, don't put it on the wound.

If the wound is bleeding or oozing fluid, you can apply a dressing. Types of dressings include various adhesive bandages, gauze, pads and tapes. The dressing you choose should be big enough to cover the wound, be absorbent and protect from further injury.
If you are overwhelmed by the number of choices of dressings (and believe me, there are oodles!), ask your pharmacist to recommend one. Change your dressing if it becomes saturated or dirty. Once the wound is scabbed over, you can stop using dressings.

Antibiotic ointment or cream may be applied sparingly to small open wounds to help prevent infection.

If you notice signs of infection, such as redness and swelling around the wound, pus or increased pain, see a doctor as you may need oral antibiotics. If you have a large, deep cut where the edges do not stay together and there is excess bleeding, get medical help.

Ready . . . set . . . go enjoy summer!

So get ready for summer! Don't be one of those red-faced, itchy, hurting people flooding the pharmacy on that first sunny, warm day of the year. For sunburn, bug bites and minor cuts and scrapes, a little prevention is truly the best medicine.