What is the treatment for hives caused by sunscreen?

Treatment of Hives from Sunscreen

Immediately discontinue the offending sunscreen and treat with non-sedating oral antihistamines as first-line therapy. 1, 2

Immediate Management

Discontinue the Allergen

• Stop using the sunscreen immediately upon development of hives, as continued exposure will perpetuate the reaction 1
• Identify the specific active ingredient causing the reaction, as most sunscreens contain multiple chemical UV filters 1, 3
• The most common allergens in modern sunscreens are benzophenone-3 (oxybenzone) and dibenzoyl methanes, while PABA (rarely used today) was historically the most frequent culprit 1, 4

First-Line Pharmacologic Treatment

• Prescribe non-sedating H1-receptor antihistamines as the mainstay of therapy for sunscreen-induced urticaria 5, 2
• Recommended agents include:
  • Fexofenadine 180 mg daily 5, 6
  • Loratadine 10 mg daily 5, 6, 7
  • Cetirizine 10 mg daily 5, 6
• These second-generation antihistamines are preferred because they lack sedating effects and have superior safety profiles 2

When to Escalate Care

• Seek immediate medical attention if signs of anaphylaxis develop, including difficulty breathing, throat swelling, or systemic symptoms 7, 2
• Laryngeal involvement can lead to fatal asphyxiation in severe cases of angioedema 2

Identifying the Specific Allergen

Common Culprits

• Benzophenone-3 (oxybenzone) is currently one of the two most frequently cited allergens in sunscreens 1, 4
• Oxybenzone can cause contact urticaria, allergic contact dermatitis, and photoallergic contact dermatitis 4
• Dibenzoyl methanes represent the other most common current allergen 1
• Skin irritation (non-allergic) is more commonly reported than true allergic reactions 1

Distinguishing Reaction Types

• Adverse reactions to sunscreens can manifest as allergic contact dermatitis, irritant contact dermatitis, phototoxic reactions, photoallergic contact dermatitis, contact urticaria, or rarely anaphylaxis 3
• Nearly all adverse effects are related to organic (chemical) UV filters due to their lipophilic character and small molecular size allowing skin penetration 3
• Inorganic UV filters (zinc oxide and titanium dioxide) possess minimal skin-irritating properties or sensitization potential 3

Long-Term Management and Prevention

Switching Sunscreen Products

• Recommend mineral-based sunscreens containing zinc oxide or titanium dioxide for patients with confirmed allergic reactions to chemical UV filters 1, 8, 3
• These inorganic filters provide effective photoprotection without the sensitization risk of organic filters 8, 3
• Patients should be aware of active ingredients and try sunscreens with different chemical groups if they experience adverse effects 1

Comprehensive Sun Protection Strategy

• Prioritize non-sunscreen photoprotection methods as the first line of defense, including avoiding sun exposure, seeking shade, and wearing protective clothing 1, 9
• Use sunscreen as a complementary measure rather than the primary protection method 1, 9
• Apply hypoallergenic sunscreens with high SPF (at least SPF 30, PABA-free, UVA/UVB protection) to exposed skin areas 1
• Wear protective clothing and hats for additional sun protection 1

Critical Pitfalls to Avoid

• Do not use sedating antihistamines (hydroxyzine, diphenhydramine) as they may predispose to dementia with long-term use and should be avoided except in palliative care 5, 6
• Do not assume all sunscreens will cause the same reaction—switching to a different chemical class or mineral-based product often resolves the issue 1, 3
• Avoid topical corticosteroids without dermatologic supervision, as they may cause perioral dermatitis and skin atrophy if used inadequately 1
• Do not continue using the same sunscreen hoping the reaction will resolve—persistent exposure will worsen sensitization 1