What is the treatment for solaralgia (sun poisoning)?

Treatment of Solaralgia (Sun Poisoning)

Immediate management of solaralgia requires aggressive photoprotection with broad-spectrum sunscreen (SPF ≥30), complete sun avoidance, and topical corticosteroids for symptomatic relief, while recognizing that this condition may represent a spectrum from acute photodamage to more complex photodermatoses requiring specialized evaluation.

Immediate Symptomatic Management

Acute Phase Treatment

• Apply potent topical corticosteroids to affected areas to reduce inflammation and pain 1
• Oral corticosteroids (40-50 mg prednisolone) may be necessary for severe cases with extensive involvement 1
• Antihistamines provide modest benefit for urticarial components, though they alone are insufficient for complete disease control 2
• High-dose H1 antihistamines (such as ebastine or cetirizine) should be combined with comprehensive photoprotection measures 2

Pain Management Considerations

• If patients experience intense pain without visible skin lesions after sun exposure, consider neuropsychiatric evaluation, as recent evidence suggests overlap with conditions like fibromyalgia and major depressive disorder 3
• Antidepressant therapy has shown improvement in both neuropsychiatric symptoms and sun sensitivity in patients with severe solar dysesthesia 3

Photoprotection Strategy (Critical for Prevention and Recovery)

Sunscreen Application

• Use broad-spectrum sunscreen with SPF ≥30 daily, containing avobenzone, titanium dioxide, zinc oxide, or ecamsule 4, 5
• Apply more than half a teaspoon each on head/neck and each arm, and more than a teaspoon each on torso and legs (approximately 2 mg/cm²) 5
• Daily application is essential—intermittent use, even with higher SPF products, results in significantly increased sunburn cells, inflammation, and Langerhans cell depletion 6
• Reapply frequently, as sunscreens are typically under-applied at only 25% of recommended doses 5

Physical Protection Measures

• Avoid sun exposure during peak UV hours (10 AM to 4 PM) 4, 5
• Wear broad-brimmed hats, long-sleeved shirts, and long pants 4
• Seek shade and avoid UV-reflective surfaces (sand, snow, water) 5
• Consider UV-blocking films on windows 5
• Eliminate photosensitizing medications if possible 4

When to Escalate Care

Indications for Dermatology Referral

• Symptoms persisting despite aggressive photoprotection and topical corticosteroids warrant specialized evaluation 2
• Recurrent episodes suggesting polymorphic light eruption or chronic actinic dermatitis require phototesting 4
• Patients with severe photodamage need annual dermatologic surveillance due to elevated skin cancer risk 7

Specialized Interventions for Refractory Cases

• Phototherapy (PUVA or NB-UVB) administered in early spring may be considered for polymorphic light eruption when photoprotection alone is insufficient 2
• PUVA therapy carries significant risks including dose-dependent squamous cell carcinoma risk and should be limited to 150-200 treatments maximum 1
• Retinoids can be added as dose-sparing agents with skin cancer prophylactic action 1

Critical Pitfalls to Avoid

• Do not use ciclosporin in patients with history of PUVA therapy, as it significantly accelerates skin cancer development 1
• Avoid maintenance phototherapy regimens to minimize cumulative UV exposure and cancer risk 1
• Do not dismiss patients with severe pain but no visible lesions—they require neuropsychiatric evaluation 3
• Sunscreens alone provide incomplete protection; they must be combined with physical barriers and behavioral modifications 2, 5

Long-term Monitoring

• Annual skin examinations are essential for patients with chronic photosensitivity to detect premalignant or malignant lesions early 4, 7
• Regular self-examination should be taught to all patients with significant photodamage 4
• Patients with severe photodamage have elevated risk for keratinocyte cancers requiring ongoing surveillance 7