The warmer summer season can be a real challenge for problem skin. Even for very sensitive skin with a tendency to sun allergy, not everything is “blissful sunshine” in summer.

Clients with problematic skin conditions such as blemished skin or rosacea require special care in summer that goes beyond the appropriate sun protection.

In case of rosacea, the persistent severe facial redness with sometimes inflammatory papules and pustules is a condition that often worsens in summer, as UV radiation can cause an acute flare-up. The chronic inflammatory disease occurs mainly in fair skin types (skin types I and II according to Fitzpatrick) and was therefore also called the “curse of the Celts” in the past.

The characteristic skin changes occur especially in the middle face, i.e. on the forehead, nose, chin and cheeks, initially recurring in episodes and later becoming more persistent.

Finding the causes

The tendency to react to different stimuli and trigger factors with a facial redness is inherited. In case of rosacea, it is assumed that the genes are responsible for about 50 percent of the development of rosacea. That also explains why this skin disease occurs more frequently in certain families. The exact causes are not yet fully understood, but many different factors seem to play a role. These include:

• a disorder of the innate immune system
• local inflammatory reactions to microorganisms of the skin, and
• changes in blood vessel regulation and possibly lymphatic vessels.

Trigger factors for a rosacea flare-up can be spicy and hot food, drinks, alcohol consumption and also psychological stress – but also climatic influences such as cold, heat and UV radiation.

Heat as a stress factor

The stimuli can vary between individuals, but especially the heat in summer is very often the trigger for a flare-up of the condition. The background: Sunlight is made up of different rays: UVA, UVB, infrared rays and visible light. Infrared rays are heat rays that promote the already existing vasodilatation in rosacea patients. The heat rays cause the veins to dilate, resulting in a “flush” (sudden blushing). More severe redness and possibly also more severe inflammatory processes may be the result.

Skin care do’s and don’ts

Basically, some basic cosmetic rules apply to rosacea, such as:

• gentle cleansing with mild-temperature water
• avoid peeling products
• only light, balancing fluids and gels for daily care should be applied and
• avoiding occlusive (sealing) masks.

In summer, a high, well-tolerated sunscreen should also be used regularly on a daily basis. This can either be included in the day care product or simply be applied as a practical on-top product or even over make-up.

As with all other cosmetic products, rosacea patients should pay special attention to the fact that the UV protection products have been specifically developed for sensitive skin. Precisely, this means: using at least sun protection factor 30 or even better 50.

Comprehensive & light

A balanced UVA protection (i.e. at least 1/3 of the UVB protection) should also be ensured. Well-known manufacturers and dermatological products already take sufficient UVA protection into account in all products with sun protection. These should also be fragrance-free and enriched only with soothing active ingredients. Excessive occlusion and richness are generally not recommended for rosacea skin. It is therefore better to always use light O/W (oil-in-water) products that also have a cooling effect.

To cover redness in the facial area, special preparations such as blemish balms can be used partially or over a wide area. They conceal the redness with brown or green pigments and at the same time have a calming and anti-inflammatory effect for the skin. The light/sun allergy known in medicine as polymorphous light dermatosis is not a real allergy in the classical sense, but it is often a concern in the summer.

Easy to mix up – Miliaria cristallina

Similar in appearance to sun allergies are heat pimples (Miliaria cristallina). However, they have a different cause: they can develop when the outlets of the sweat glands swell up and become blocked due to heat accumulation. A kind of congestion occurs in the pores and small, itchy, watery blisters appear – mostly on the cleavage and upper body. Regular cleansing to remove sweat and bacteria from the skin is a good preventive measure. Wearing airy clothing is also recommended to reduce perspiration and heat accumulation.

2.5% of the population in Germany suffer from the skin disease Rosacea, which can occur in flare-ups.

When the sun is out: blisters are too!

The causes of sun allergies are not yet fully understood, but there seems to be a certain genetic predisposition to a hypersensitivity reaction. Polymorphic means multifaceted and expresses that the skin symptoms can be individually very different. Mostly, sun allergy affects women with fair skin types, who have particularly light-exposed areas such as the side of the face, the cleavage, the upper arms and the neck, upper arms and shoulders are very sensitive to UV radiation. Hours to a few days after a single exposure to the sun, various skin changes develop in the affected areas, such as

• redness
• small red raised nodules
• (papules) or
• small blisters with watery clear contents.

The skin changes are usually accompanied by intense itching. They often recur in the same place, especially during the first sunbath of the year, because the skin is not yet “accustomed” to the sun.

Stay in the shade or get prepared

If you have a predisposition to sun allergy, it is recommended to avoid the sun and to protect or support the skin through various measures – e.g. by gently getting it used to the sun through light therapy (“light-hardening”) or taking beta-carotene.

This can help the skin to build up a certain natural protection from the inside. In addition to natural light protection through textiles, the consistent use of sunscreens with high UV protection is also obligatory for the care and protection of the skin. It should be products with UVA and UVB protection, although UVA protection is particularly important. In case of pronounced itching, anti-allergy medicine (antihistamines) can be taken for a short time.

The so-called acne mallorca (Acne aestivalis) is also a type of sun allergy that often affects women with fair skin. In this case, small reddish, sometimes inflammatory nodules form on sun-exposed areas such as the cleavage, the upper back, the shoulder area and the neck, often accompanied by severe itching. In contrast to the classic polymorphous light dermatosis, the skin changes are follicle-bound, which is why the name “acne mallorca” has come up. However, no comedones appear!

Please avoid these substances

The cause is not only UV radiation and a corresponding sensitivity to it, but an interaction of UVA rays with certain emulsifiers or lipids in body care products or sun protection preparations. Under the influence of the UV rays, the skin’s own sebum together with the lipid and emulsifier components of the emulsions can form so-called lipid peroxides. These lead to the skin changes described above in people, who are predisposed to them and slowly disappear as soon as they are no longer exposed to sunlight. To prevent acne mallorca, it is not only important to have a high level of UV protection. Sunscreen and after-sun preparations should be used which contain almost no peroxide peroxide-forming substances (such as certain fats and emulsifiers). The best option for affected persons would be oil-free gels and special lotions.

Pleasure and relief: With regular exfoliation impurities, for example on the back, can be relieved or even avoided.

Production at full speed

Basically, it must be noted that sebum production increases somewhat in the summer months, which is why problems with blemished skin in general also occur more frequently during that time. The T-zone is particularly affected, sometimes also the back. The skin is more shiny and the excess sebum promotes inflammation as it cannot drain off sufficiently. If the pore exits are also blocked, e.g. because dead skin cells are not sufficiently desquamated, inflammation can develop under the influence of bacteria in the sebum.

Skin care tip

To treat and calm the itchy blisters, gels with Aloe Vera can be recommended. In more pronounced cases, local hydrocortisone lotions or creams can be used likewise.

The clean thing!

Therefore, both the face and the back, should be cleaned thoroughly and regularly, particularly in summer.

Since the back is not easily accessible, this is another factor in the development of impurities and inflammation. To avoid that, rich sunscreen products should not be used, as they are counterproductive with high levels of oil components.

In addition, regular exfoliation can help keeping the pores free of sebum, dirt and bacteria. They also remove dead skin cells evenly and prevent the pores from becoming clogged.

Especially for treatment on the body (e.g. on the back) but also for facial care, it is advisable to consult a specialist regularly, especially during the warm season. This way, a professional treatment of impurities is guaranteed and the affected clients with impure skin will also get through the summer just fine.

Dr. med. Christine Schrammek

The managing director of Dr. med. Christine Schrammek Kosmetik GmbH & Co. KG is a dermatologist and allergologist. As an anti-aging expert, she develops treatment methods such as the GREEN PEEL® herbal peeling treatment and dermatological care products.

Christina Drusio

is part of the Dr. med. Schrammek owner family and management of Dr. med. Christine Schrammek Kosmetik GmbH & Co. KG. As an expert of sensitive skin, the Medical Specialist for Dermatology and Venerology is a valued speaker at international lectures and seminars.