In addition to hot weather and holidays, summer can bring with it several common skin problems, including sun damage, stings and bites. We take a closer look at how 6 common problems can be prevented and treated if you should be unlucky.
Written by Carsten Sauer Mikkelsen and Kristian Bakke Arvesen
Various sun injuries, bites and stings can both hurt and pose a risk of permanent damage.
The article contains advice on:
- Sun rash
- Bee and wasp stings
- Viper bite
- Face piece
- Tick bites
Sunburn is a sun damage that occurs with excessive sunbathing, and is a first-degree burn that causes an inflammatory reaction in the skin. How much sun you tolerate before you get burned depends a lot on your skin type, and people with light skin type get burned more easily than those who get brown quickly.
In addition, some medicines may increase the risk of sunburn. The most common drugs that can increase the risk of this are some heart medications, some painkillers and some types of antibiotics.
Ultraviolet radiation from natural sunlight or artificial light (solarium) can cause sunburn with redness, swelling, itching and burning in the skin. The symptoms typically disappear within a few days, but can be experienced as bothersome while you have them.
In particular, UVB radiation can cause direct DNA damage in the skin so that mutations in the cells occur and thus increase the risk of developing skin cancer. There are mainly 3 types of cancer that affect the skin: malignant melanoma (mole cancer), basal cell skin cancer and squamous cell skin cancer.
A lot of UV radiation can also cause wrinkles and pigment spots.
How to treat sunburn?
In case of severe itching, antihistamines can be used.
Creams that contain adrenal cortex hormone can be applied to the burned areas. Generally, it is sufficient to use mild steroid creams (strength I-II) for a few days.
If you are receiving light-sensitizing medicines, you should take a break from them if you can not avoid continuing to stay in sunlight (such as tetracyclines). Cooling creams and possibly wet wraps can also relieve the symptoms.
Prevention of sunburn
- Use sunscreen with a high enough sun factor - and use enough sunscreen (a large handful for the whole body for adults).
- Lubricate yourself 15-30 minutes before going out in the sun so that the sunscreen can soak in.
- Repeat the lubrication often, especially if you sweat a lot or bathe.
- Sunbathe gently in the beginning, and take regular breaks from the sun.
- Wear clothes, headgear and sunglasses for extra protection.
For more information on sun damage read the article Use sunscreen: Take care of your skin in the sun.
2. Sun eczema
Sun eczema is also referred to as sun allergy. In technical language, it is called polymorphic light rash. The rash typically occurs as transient eczema in the spring months.
Sun eczema differs from sunburn in that it takes less sun exposure before the eczema appears than for sunburn.
Around 15% of the population in the Scandinavian countries develop this type of rash. It is primarily among young women aged 10-30 years that this occurs. Some medications, such as antibiotics, can make the skin more sensitive to sunlight and can thus help trigger sunburn.
Both the UVA and UVB rays from sunlight can cause sunburn by causing reactions in the skin that the body perceives as foreign. Therefore, a counter-reaction occurs in the body, which causes a local inflammation.
With sun eczema, the skin becomes red and warm. Often you also get a little swollen. Small reds also form
dots and blisters on the skin.
If sun eczema is suspected, light tests are sometimes performed to find out which spectrum of light one is reacting to.
Prevention of sun eczema
- Use a sun protection factor with a high protection factor.
- Minimize body exposure to sunlight.
- Wear clothing that covers the area with sun eczema.
Curing the skin before the sun's first strong ultraviolet rays come can help. This can either be done by initially only staying in the sun for short periods, and then gradually increasing
In rare cases, require the use of either UVB or UVA (PUVA), then curing of the skin can take place at a dermatologist.
This is done by controlled light treatment on the skin. The curing means that the skin eventually does not react with a rash when you get natural light on the skin.
Systemic treatment with immunosuppressive drugs such as Azathioprine (Imurel) may be necessary in rare cases.
If you have sunburn, it is important to stay away from the sun. Eczema can be relieved with cold compresses, but for troublesome itching, allergy-suppressing and anti-itching medicines can also be used (available without a prescription at a pharmacy).
To reduce the rash itself, you can use mild cortisone-containing creams, such as over-the-counter
3. Bee and wasp stings
Bees and wasps belong to a group of insects (Hymenoptera) that also include wasps and ants. The bees include common honey bee and hops. The most common wasps are the common wasp (Vespula vulgaris) and the European wasp (Vespula germanica).
Common to bees and wasps is that the sting is poisonous, for defensive use for the species. The bees only sting in self-defense, therefore it is more common with stings in beekeepers and most common in spring and summer. The wasps usually bite in late summer and autumn, when the number is greatest.
The toxins from these insects consist of biogenic amines, basic peptides and proteins.
The sting triggers a toxic reaction, including vasodilation (dilation of blood vessels). The biogenic amines and peptides cause local swelling and burning pain, while the proteins cause the allergenic effect (sensitization).
Allergic sensitization can develop after just one bite and can be documented by the detection of allergen-specific antibody IgE (checked with a blood test) against either bees or wasps.
After previous sensitization, a new sting may trigger an allergic-anaphylactic reaction.
The anaphylactic reaction is manifested as redness of the skin, hives and angioedema. In the respiratory tract, asthma, shortness of breath and cough develop. In the gastrointestinal system one can observe abdominal pain, diarrhea and vomiting, and in the cardiovascular system (peripheral dilatation) dizziness, palpitations, heart rhythm disturbances, drop in blood pressure and circulatory collapse with unconsciousness.
The anaphylactic reaction develops rapidly after the sting, usually within a few minutes to half an hour.
The risk of severe or fatal anaphylactic reaction is most pronounced in the elderly and is rare in children.
Toxic / allergic reaction:
In case of toxic reaction, a locally itchy, burning painful rash is seen.
If you are stabbed in the oral cavity or get many stings at once (for example when removing
wasp nest) it can be life threatening.
The allergic reaction may be local (grade 0) with large blistering (> 10 cm in duration
> 24 hours) or systemic (grade 1-4) from universal urticaria (grade 1) to circulatory collapse and
unconsciousness (grade 4).
If an allergic reaction is suspected after being stung by a bee or wasp, it is examined for allergen-specific antibodies (IgE bee or IgE wasp) 3-4 weeks after the sting.
Treatment of allergic reaction:
The poison sting must be removed immediately. If anaphylaxis has been documented for bees and / or wasps, patients must bring "emergency medicine" throughout the season. That is, antihistamines, prednisolone and EpiPen. 113 or other medical personnel are contacted if anaphylaxis is suspected.
Immunotherapy or allergy vaccination is an effective treatment for bee and / or wasp allergy. Conditions such as immune deficiency, chronic severe heart-lung disease, beta-blocker treatment, angina pectoris, uncontrolled hypertension make it impossible to receive immunotherapy.
Contraindication due to beta-blocker treatment is relative due to the life-threatening effect of anaphylaxis.
Vaccination against wasps shows> 90%, for bees a little less (75 - 90%). The effect of allergy vaccination lasts up to 20 years after the course of vaccination, which usually extends over 3-5 years.
4. Viper bite
The adder (Vipera berus) is the only free-living venomous snake in Norway. It is widespread in most of Europe and is also found in large parts of Asia. They are found in marshes and forest areas, among other places. In winter, the viper is dormant, but from March to October it is active, which poses a danger of being bitten.
The adder has hollow fangs connected to venom-producing glands. The teeth can penetrate 2-3 mm into the skin, where the poison is injected. More men are bitten in the arm or hand compared to women, as men are more likely to pick up the snake.
A bite hurts and the poison starts to work after 10-20 minutes. Tooth marks are seen on the skin
fangs, redness, discoloration and swelling that can spread to a larger part of the extremity within a few hours.
However, about 30% of bite cases do not cause symptoms, as no poison is injected - so-called
In severe cases of poisoning, nausea, abdominal pain, vomiting, palpitations and fainting occur. In the blood samples you can see an increased number of white blood cells and platelets. On cardiac cardiogram you can see changes such as blockages in the heart's conduction system.
In general, treatment of viper bites should be given after considering the degree of poisoning and the progression of symptoms. Viper bite is an acute condition and potentially serious, therefore the patient should be transported to the nearest emergency room as soon as possible.
Treatment of viper bites
- Prehospital, it is important to calm the patient as well as raise and immobilize the body part of the bite
- Pain treatment can be started.
- Nausea is given as needed.
- In severe cases of allergic reaction, intramuscularly injected adrenaline (0,5-1,0 mg)
- The extent of the discoloration around the bite site has been plotted to be able to follow changes.
There is an antidote (ViperaTAb) against viper bites in the country's emergency rooms, which should be considered if
the swelling spreads and systemic symptoms develop.
Tetanus syringe should also be given.
It is important to be aware that there are many false myths about the treatment of snake bites in
circulation. Possibly inspired by Hollywood movies, some people try to suck the poison out of the bite,
or tying a tourniquet around the affected extremity. This is not recommended.
5. Face piece
Fjesing (Trachinus draco), also called the "sea worm", is a fish found in the Kattegat, Skagerrak, North Sea, Northeast Atlantic and Mediterranean and Black Sea. In Norway, one should be aware that it is found from the Swedish coast and up to the Trondheim Fjord.
Fjesing is often partially buried in the sandy bottom, and unfortunate bathers can be stung on the fish's dorsal fin if they step on it. Fjesing is also notorious among anglers, who risk getting stung on the fish when it is pulled up in the net or with the line. The spikes on the anterior dorsal fin and on the gill caps are connected by glands that contain venom.
Immediately after a sting, the victim may feel localized, intense pain in the affected body part. The first 5-10 minutes you get pain around the injection site, but these can then spread to the entire extremity.
Untreated, the pain can last for 24 hours and in some cases continue for several days or weeks. Objectively, slight swelling and discoloration can be seen around the puncture site, and the area feels warm. In severe poisoning, nausea, headache, chest pain and difficulty breathing may occur.
In the worst case, the poisoning can lead to death.
Long-term late complications in the form of pain, swelling and joint stiffness have been reported in some cases.
Treatment of face bites
There is very limited evidence of the effective treatment of face bites, but the following is recommended:
- The affected part of the body should be immersed in hot water at 40-50 ° C as soon as possible. This
should deactivate the poison and at the same time reduce the symptoms. Treatment should continue until the pain subsides
themselves (often after 30-40 minutes), or up to 90 minutes. If hot water is not available, can
the body part is covered with warm sand or similar.
- Make sure that the entrance wound is clean and that any remnants of a spike are removed.
- Pain medication is given as needed.
- If there are signs of an adjacent infection, a doctor should consider antibiotic treatment.
- Remember tetanus vaccination if the person has not recently received a booster vaccination.
6. Tick bites
The forest tick (Ixodes ricinus) is found in humid environments such as forests and meadows, especially where there are many deer.
The tick usually sits some distance above the ground for example in tall grass and waits for an animal or
human must come by. The tick is active from early spring to late autumn, where it can bite and suck blood.
To minimize the risk of infection, it should be removed as soon as possible after it has taken hold.
There are various recommendations for removing ticks:
- Use tick remover, tweezers or two nails. Grasp the tick as close to the skin as possible and pull it
- The bite site is washed and cleaned.
If you are bitten by a tick, it is important to monitor for possible symptoms afterwards.
In Norway, the most frequently transmitted disease in tick bites is Lyme borreliosis, which is caused by infection with the spirochete Borrelia burgdorferi sensu lato. Clinically, the disease is divided into 3 stages.
- In stage 1 (Early localized infection - erythema migrans). Here, after 7-14 days, you can see an expanding, well-defined or annular redness in the skin, typically where the tick has bitten. Diagnosis is made on the basis of anamnesis and clinical examination, as only approx. 60% of patients have measurable, specific antibodies in their blood.
- Stage 2 (Disseminated infection, early stage) covers a number of clinical manifestations; multiple erythema migrans, borrelia lymphocytoma, early neuroborreliosis, borrelia carditis (inflammation of the heart) and arthritis.
- In stage 3 (Disseminated infection, late stage) acrodermatitis chronica atrophicans and chronic neuroborreliosis are seen. Patients with neurological or cardiological symptoms should be referred to a hospital.
Ticks encephalitis (TBE)
Tick encephalitis (TBE) is caused by a virus that can be transmitted by tick bites.
The majority of infected people who are infected with the TBE virus do not develop symptoms. For those who are infected, a two-part course is often seen that starts with fever, headache, fatigue and nausea as well as muscle and joint pain.
After a period of a few days to a few weeks, almost half of the patients develop signs of meningitis (meningitis) and encephalitis (encephalitis). The diagnosis is made by detecting antibodies and viruses in blood and spinal fluid.
There is no specific treatment for TBE, but vaccination is recommended for people living or moving in TBE endemic areas.
Anaplasmosis, also called Ehrlichiosis, is caused by the bacteria Anaplasma phagocytophilum and Ehrlichia species. This is the most common tick-borne infection in animals in Europe.
The infectious agent is also common in tick areas in Norway. Nevertheless, not many clinical cases of human anaplasmosis have been registered in this country.
Infection after tick bites can cause flu-like symptoms such as fatigue, headaches, muscle and joint pain and fever. Penicillin and doxycylin, both of which are antibiotics, are recommended for the treatment of tick infections.
The duration of treatment depends on the clinical findings and the medical history.