Photosensitive Reactions

by Judie Bizzozero

Every salon professional lives by the rule of sensible, moderate and responsible tanning. That means educating your customers and staff about the dangers of overexposure and the subject of photosensitivity. There are instances where a customer may have a photosensitive reaction to ultraviolet light and think it’s a sunburn, and it is up to the salon operator to educate the consumer.

Photosensitivity is a physical reaction that occurs in varying degrees to a certain portion of the population. It occurs when different drugs or medical conditions react with ultraviolet light to cause the body to become more sensitive regarding the skin’s acceptance of ultraviolet light.

The chemical may enter the skin several ways—orally, topically or parenterally (not through the digestive tract)—but must be present when the skin is exposed. Compounds that cause photosensitivity usually are cosmetic or therapeutic in nature. Sometimes the chemical changes that occur reduce the skin’s ability to defend or heal itself. Some medications specifically are designed to enhance the immune system or reduce the immune response. There also are medical conditions that cause a similar response.

Hopefully, a tanning customer will be aware of any medical condition and will have been told by his or her physician to be careful of sun exposure. However, it is the salon owner’s responsibility to inform the client that ultraviolet light is the same whether it is emitted from the sun or from a tanning unit.

There are a number of reactions that can occur from mixing certain medications with ultraviolet light. The reaction is almost the opposite of putting sunscreen lotion on the skin. For example, an SPF 8 lotion is formulated to allow a person to remain in the sun for eight times as long without burning. In the case of a photosensitizing agent, the individual only may be able to be out in the sun for one-fourth the time he or she normally can before getting erythema or sunburn.

It also is important to note that certain drugs are more photosensitizing than others. For example, Tetracycline, Thiazide and anti-cancer drugs such as Interferon top the list as most likely to cause a severe reaction.

Salon operators must be aware that each individual is different and there are varying portions of the population that will react to any given medication or product.

Additional points to consider are formulation, metabolism, elimination factors and photochemical reactivity, as well as the method of administration. Factors associated with radiation include the special irradiance of the ultraviolet source, dose and rate of delivery, number and frequency of exposure, and the timing of the radiation relative to the presence of the chemical in the body. Refer to a list of photosensitizing drugs and agents at www.lookingfit.com. While this list is comprehensive, it does not list the newer medications on the market. If you have any concerns, have your customers consult with their doctors or pharmacists to see if they can withstand UV exposure—indoors or outdoors.

There are two types of photosensitive reactions—phototoxic and photoallergic. It can be difficult to distinguish between the two types of reactions, and a substance or medication is capable of producing both reactions.

Photoallergic reactions usually occur due to substances applied to the skin but can be caused by substances ingested or injected. The reaction is the result of UV light structurally changing the substance and, in turn, causing the skin to produce antibodies, resulting in allergic reaction.

The symptoms typically appear as eczema-like skin conditions, but also can present as lesions or hives. Symptoms usually appear on exposed areas of the body, but the reaction can spread to nonexposed areas of the body. Symptoms usually are delayed for 24 hours up to several days, and the recovery period often is slower than that of phototoxic reactions.

It is important to note that photoallergic reactions are not dependent on the amount of substance applied, ingested or injected. These reactions require prior or prolonged exposure to the substance and do not occur during the initial exposure to the substance. After the initial exposure period, continued exposure to the substance, even in small amounts, will cause a photoallergic reaction. They are more common in adults than children. Reactions can occur due to chemically related substances by cross-sensitivity or cross-allergenicity.

Phototoxic reactions are more common than photoallergic reactions and are caused by substances that either can be ingested, applied to the skin or injected.

A phototoxic reaction occurs when the substance absorbs energy from UV light and releases the energy into the skin. This energy causes skin cell damage or death. The reaction usually occurs quickly—within seconds to hours after exposure. The symptoms usually appear only on the parts of the body that were exposed and present as a sunburn/erythema, pain, blistering, hyperpigmentation and peeling.

Phototoxic reactions can occur on first exposure to a substance and usually do not show cross-sensitivity.

The clinical features of photosensitive reactions vary with the chemical and the individual. Skin eruptions tend to occur in areas of greatest exposure. In the event of an injury developing from overexposure to ultraviolet light in a tanning facility, medical advice or attention should be sought immediately. In the incidence of a photosensitive reaction, exposure to ultraviolet radiation should be stopped at once.

Tanning facilities that are regulated by state law are required to submit a written report of the incident within five working days.

For mild sunburn, cool compresses should be kept on the affected area until the pain subsides. Soaking with Aveeno Oilated oatmeal, cold cream and other bland medications are fine for mild sunburns. Do not use any anesthetic ointment with the word “caine” in it, as this could cause a severe allergic reaction. If an eye injury is incurred, immediately refer the client to an emergency room or ophthalmologist.