The sun turns me into The Fly.
June 7, 2011 7:44 AM   Subscribe

YANMD, but MD(ermatologist) can't see me until October (!), thanks to some excellent health insurance. Last summer I started, seemingly out of nowhere, having a very odd and very severe reaction to the sun on my face - whiteheads, all over, almost literally in crops all over my face. If you picture a person's skin being almost completely swapped for whiteheads, that's along the lines of what I had (not on eyelids, etc, but it hurt and felt horrific). It might be getting worse, I can't get to see a dermatologist, and I work outside in the summers - is there any help for me this summer?

More info: I have student health insurance and am thusly tied to my university's health services. I ran this problem past a GP recently and they just said, "go to Derm," but Derm only works one morning a week, so they're backed up for months. I can't afford to pay out of pocket to go out of plan, so that's pretty much it for my legitimate medical options until the fall.

The background: I work outside all summer, every summer. I do what I can to avoid sunburns, but sometimes the amount of sweat and general busy-ness means that I get overexposed and burns do happen. Last year, I burned - came home, put on aloe with lidocaine, as usual, and about 3 hours after the burn, my face started to throb. Turns out, my entire face was sprouting whiteheads, from my hairline to my jawline. There were probably a couple hundred of them - it was genuinely disgusting. After this happened twice, I realized it wasn't any product I used or something I ate, but rather the burn - the whiteheads followed exactly the line of the burn, and wouldn't appear anywhere that wasn't overexposed. Sunscreen helped avoid this, but not entirely - and, again, with how much I sweat while working, sometimes I simply can't maintain the coverage I need. (Obviously, I will have a gigantic-brim hat this year, but last year all I had access to was a baseball cap - not enough shade).

This year, I wonder if it might be getting worse. I went for a run three days ago around 3pm. I slathered myself in sunscreen, but sweat through it within about 15 minutes. I came home and had no burn, but began to break out around where the sweat was the worst. It seems now that maybe I'm getting more sensitive?

There is no way I can avoid being in the sun. I try to minimize it when possible, but honestly the option is quitting my job and damaging my career, so that won't happen. I will have a series of shady hats, and I am looking into some more persistent sunscreen - though I've always had very sensitive, acne-prone skin so most sunscreens make me break out just from their ingredients. I'm in a bit of a catch-22.

So, without access to a derm/good doctor - what can I do? What might this be? Google is almost no help, and when google + doctors aren't helpful... dear god, I feel like I'm on my own.

Me: 30, blonde with extremely fair, freckly skin. No previous horrible burns, but constant sun exposure each summer. No preexisting medical conditions, though I have been very fatigued this year, inexplicably, despite having decent sleep, fine iron levels, thyroid, etc etc (fatigue is another thing the drs didn't help with - one said, "in a college, everyone has mono. I can't even test you for it." I've already had mono. But that was the dismissal.) Also, the skin on the rest of my body has been very itchy lately - no outward signs as to why, but I'm just generally kind of ... prickly. Though I'd chalked that up to our insane pollen at this time of the year. The pimples themselves are of only one type - small whiteheads. No cystic acne seems to come from the sun exposure.

Tl;dr - fair-skinned female started severely breaking out last summer from sunburn, situation may be getting more sensitive. About to go abroad to work outdoors for 6 weeks, hats only do so much. Doctor can't see me until fall. Help??
posted by AthenaPolias to Health & Fitness (12 answers total)
I know you described them as whiteheads, but consider reading up on sun allergy. It can be exacerbated by some prescription drugs, especially antibiotics, and, surprisingly, by some sunscreens.
posted by hydropsyche at 8:06 AM on June 7, 2011

try to find a good esthetician in your area and get a deep cleansing facial if you can afford it. they may also be able to recommend products or strategies to better take care of and protect your skin.
posted by supermedusa at 8:07 AM on June 7, 2011

A question: are you absolutely certain this is acne, and not some other similar-seeming skin condition? Because this sounds to me like polymorphous light eruption, a condition which causes a rash which can blister in certain cases. hydropsyche mentioned sun allergies; this is one kind.There are potentially ways of getting yourself acclimatized to the sun with UV treatments, but these are going to involve seeing your dermatologist.

My suggestion? The next time this happens, just walk into your dermatologist's office. Tell them that you've got an appointment in October, but that you need to see them sooner than that. If your symptoms are as bad as you say they are, one look should get you some attention. Dermatology isn't generally considered a discipline that deals with emergencies--they basically work from 9-5 a lot of the time--and the vast majority of the time, whatever it is a patient has can probably wait and may well be cosmetic anyway. Coming in with dramatic symptoms like that may be helpful in convincing them that you're not actually messing around.
posted by valkyryn at 8:15 AM on June 7, 2011 [9 favorites]

No previous horrible burns, but constant sun exposure each summer. No preexisting medical conditions, though I have been very fatigued this year, inexplicably, despite having decent sleep, fine iron levels, thyroid, etc etc (fatigue is another thing the drs didn't help with - one said, "in a college, everyone has mono. I can't even test you for it." I've already had mono. But that was the dismissal.) Also, the skin on the rest of my body has been very itchy lately - no outward signs as to why, but I'm just generally kind of ... prickly.
Eep. I am not a doctor and do not play one on TV, but photosensitivity (bad reaction to sun) and fatigue are both things that happen in autoimmune diseases like lupus. I would call back your GP, ask if this could be photosensitivy/ an autoimmune problem. When your iron and thyroid were tested, did they test for autoimmune stuff?

I have found that "emergency" is often the magic word that you need to use to get an early appointment with a booked-up specialist. They have some emergency appointments set aside. They just need to be convinced to put you in that category.
posted by craichead at 8:25 AM on June 7, 2011

Do you gave a picture? Show it to your doctor and don't say "whitehead" because it's inaccurate and makes your problem sound much less worse than it is.
posted by acidic at 9:46 AM on June 7, 2011 [1 favorite]

Response by poster: Thanks so much for the answers so far. hydropsyche, valkyryn, and acidic: I've had acne since I was 10 and these eruptions are absolutely whiteheads. They look identical to every non-cystic pimple I've ever had, and are just like when I accidentally get something comedogenic on my face. They appear like whiteheads, have pus like whiteheads (I hate every time I have to type that word... eech), and heal just like whiteheads. It may sound minimal/superficial in theory, but the sheer amount of them should counter that?

I would love to be able to walk into a derm office the next time this happens, but short of sitting outside to get a sunburn on Monday so I can be there Tuesday morning, that isn't likely. I'm abroad when I get this sun exposure and our medical options in town are pretty poor, so I'm probably best avoiding the reaction as much as humanly possible now and dealing with it when I get home? That said, craichead, I just took your advice and emailed my doctor about autoimmune tests. She's having me come in tomorrow for bloodwork and will put me on the dermatology cancellation list - though I've only got two weeks before I leave for the summer. But there's still a chance?
posted by AthenaPolias at 10:34 AM on June 7, 2011

Go back to health services, explain that this is urgent, demonstrate severity of problem, and ask them to find a cancellation or otherwise squeeze you in to the dermatologist.
posted by galadriel at 10:38 AM on June 7, 2011

This similar question has links to some promising wikidiagnoses. Here's some more stuff to try:
-Run in the sun followed by icepacks applied to the hottest parts.
-Run in the sun with a towel. Wipe sweat constantly.
-New type of sunscreen. Maybe Neutrogena Wet Skin?
posted by acidic at 11:13 AM on June 7, 2011

Best answer: 2nd-ing the recommendation to pursue the possibility of an autoimmune disease. The fatigue and general itchiness are suspicious, showing up with the photosensitivity. You might need a rheumatologist rather than a dermatologist.

In the meantime, some fairly harmless things you might try: after sun exsposure, take a Benadryl or other antihistamine. If it's an allergic reaction, that might help. Maybe Benadryl cream also. Or 1% hydrocortisone cream. Whether any of those things do or don't help might help a doctor figure out what's going on.
posted by Corvid at 12:51 PM on June 7, 2011

I am allergic to the sun [fair skinned and blue-eyed]. I don't get sunburned, I get hives or sun poisoning. my hives have raised white bumps, but they don't quack like the ducks that OP described so realistically.

I don't think that sunscreens work for me, it seems like they block the heat transfer mechanism of my skin. I've seen a couple Derms with my excellent PPO insurance, and they are largely useless [cortisone cream and vague instructions like "be careful"]. Search Google for dermatological photographs. There are shuddersome galleries of eyeboggling afflictions. You need to find the name of your white bumps. Are they milaria? [A cluster of red or white miliaria, small pus-filled bumps typically found on the cheeks, forehead and chin. These bumps are clogged pores -- the result of crystallized (dried) sweat trapped under the skin.]

My solution is to prevent direct sun rays from contacting my body. I wear gloves, hats, long sleeved shirts, long pants. I swim in a turtleneck [made from SPF 50 fabric].

The Australians, with fair English complexions under the blazing sun, make the best sun protective clothing.

Benadryl is a good recommendation; remember that oral Bendadryl & topically applied creams are additive, don't overdose.
posted by ohshenandoah at 1:18 PM on June 7, 2011

Could this be a reaction to your sunscreen?

It might be worth switching to a "Toddler" or "Sensitive skin" sunscreen to see if that helps.

I once reacted to very expensive and allegedly hypoallergenic Ella Baché sunscreen by breaking out in tiny, tiny blisters all over my face that looked like whiteheads...
posted by Year of meteors at 4:35 PM on June 7, 2011

Response by poster: A follow up: After having this reaction continue to get worse, I was lucky enough to be able to consult with a friend of a friend at my job, who happened to be a doctor. She reccommended that I try an antihistamine, and lo and behold, that fixed the problem perfectly. So the verdict - albeit mostly self-diagnosed - is that it appears to be a sun allergy, apparently, that manifests by a severe case of whiteheads. After going on the antihistamine, my skin went completely back to normal, but as soon as I forgot to take it, I broke out like crazy again. I still have that dermatologist appointment in October, so I'll be bringing this up with them, but the problem is resolved, at least for the time being. Thanks to everyone for all the help!
posted by AthenaPolias at 9:49 AM on August 12, 2011

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