Summer Safely: Best practices that can help you avoid being burned by the outdoors

Sunburn. Dehydration. Stings. Poison sumac and poison oak.

If one did not know any better, they might think summer is scary — what with all the possible dangers involved with simply stepping outside one’s shelter.

But it doesn’t have to be that way.

While the summer brings with it some challenges to health and safety, knowledge and some simple preparations are key to enjoying the weather and good times.

Skin care

Skin cancer is the most common form of cancer in the United States, with 4.3 million adults treated for basal cell and squamous cell carcinomas annually, according to the Centers for Disease Control and Prevention. And in 2017, the most recent year for which data is available, the country saw 85,686 new cases of melanomas of the skin and 8,056 deaths from them.

So, taking care of one’s skin when out in the sun is of the utmost importance. Dr. Danielle Baruch, a dermatologist at Mercy Medical Center in Baltimore, recommends people apply a broad spectrum sunscreen with SPF 30 or greater starting 15 minutes prior to sun exposure and every two hours when they are outside. Dr. Christine Choi Kim, a Los Angeles-based dermatologist, emphasized that finding “broad spectrum” on the label is important because it protects against both UVA and UVB rays.

“Higher-SPF sunscreens impart slightly higher protection, but no sunscreen can block 100% of the sun’s UVB rays,” Kim says.

Application is key.

“It takes about 1 ounce to cover an adult body properly in sunscreen,” Baruch says. “This is about the amount it takes to fill a shot glass or roughly the size of a golf ball.”

Because no sunscreen is fully waterproof, it also needs to be reapplied after swimming or heavy sweating, Baruch says.

“Lots of people sustain sunburns due to improper sunscreen application,” she says. “They either apply too little or forget to reapply after 2 hours or after getting their skin wet. … People often forget about the tops of their head, ears, neck and tops of the feet, so these are areas that frequently get sunburned.”

Both Baruch and Kim cautioned against spray sunscreens. While many consider them convenient, sprays can be tougher to apply properly — “apply it liberally and rub it in to ensure complete coverage” if you must, Baruch says — and their safety and effectiveness is being reviewed by the U.S. Food and Drug Administration, according to Kim.

But Kim says when it comes to other options such as creams, lotions, gels and sticks, a lot depends on comfort, ease of use and skin types. Just make sure they are not expired. Kim emphasized that if people are applying sunscreen correctly, small bottles should not be around long enough to go bad.

Sun-protective clothing is a “great option” to protect skin from the sun, but those are rated with UPF instead of SPF, Baruch says. People should look for clothing with a UPF of 50 or greater and a hat with a brim that covers the ears and back of the neck, if possible. Kim concurs.

“I really encourage my patients to think of sunscreen as just one part of a comprehensive sun-protection strategy,” she says, noting the best part of that defense may be avoiding the sun altogether at times. “Seek shade between the peak sun intensity hours of 10 a.m. and 2 p.m.”

Hydration

When it comes to staying hydrated, there are varying recommendations. And even then, there can be “considerable differences” in how much one needs based on age, gender, size, climate, level of physical activity and health conditions, according to Katherine Basbaum, a clinical dietician with the University of Virginia Health System.

But a good starting point, according to Basbaum, is the Institute of Medicine’s recommendation that women drink roughly 70 ounces of water per day while men drink 100 ounces.

“This may sound like a lot, but it’s important to remember that drinking water is not the only way to reach your hydration goals,” Basbaum says, noting cucumbers, lettuce, broccoli, strawberries and watermelon can help. “Many fruits and vegetables have a very high water content, so eating these foods contributes to your hydration efforts. Decaffeinated tea and coffee, as well as juices and some sodas count, too, but watch out for sugar.”

Warm climates and/or regular, vigorous workouts likely up the need for water, Basbaum says.

“Two good rules to live by are: drink when you’re thirsty and check in on the color of your pee every day,” she says. “The goal is a very pale yellow. For the average healthy adult, if your pee is bright or dark yellow, it is likely telling you to drink more water.”

Mild dehydration can cause symptoms such as fatigue, irritability, weakness, headache, dry mouth and dizziness, Basbaum says. While those may seem bad enough, moderate to severe dehydration can lead to consequences she calls “much more dire,” including a decline in cognitive performance, drop in blood volume that can cause blood pressure to plummet or dangerously low levels of oxygen in the body, seizures caused by electrolyte imbalances, and kidney injury, she explains.

“Staying hydrated is important for so many reasons, some of the most important being that it helps regulate your body temperature and blood pressure, promotes healthy digestion and bowel movements, acts as a lubricant for your joints, and provides a protective cushion for delicate organs,” Basbaum says. “Without proper hydration, your body cannot perform essential body functions at their optimum level.”

Insect Bites and Stings

Dr. David M. Claborn, a public health professor at Missouri State University, says the best course of action to avoid insect bites and stings is simply avoid the areas where those insects and related animals are, though he understands that is not always easy.

“For mosquitoes, it is a little hard to avoid because they can grow in such small amounts of water; however, places with lots of artificial containers often have a lot of biting mosquitoes,” he says. “Old tires, plastic containers, wrecked cars, etc., all provide excellent larval development areas and should be avoided.”

But when it comes to ticks, people can avoid wild animal trails and transitional areas between dominant forms of vegetation — such as from a forested area to a meadow — where ticks are “particularly abundant,” according to Claborn. They live year-round but tend to be “very numerous” from spring to fall in certain habitats because of their animal hosts.

If avoidance is not an option, people should wear long pants tucked into the top of boots (or rubber bands over the bottom portion of the pants to impede ticks) and long-sleeved shirts, Claborn says. Mosquito nets that cover the face can be useful, and permethrin made for clothing is available at sporting goods stores, though Claborn cautions against using other pesticides for this purpose. A repellant such as DEET can be used on exposed skin, he says.

If there is any concern of exposure to ticks, Claborn says to first check the arm pits and groin area, as well as feel the back of the head and neck, and then inspect the rest of the skin with a mirror as needed, if someone else is not available to help.

Mosquitoes are responsible for spreading the world’s most damaging vector-borne disease, malaria. It kills approximately 800,000 people per year but usually is not a problem in the United States, Claborn says. Mosquitos can also spread West Nile virus, though, which does occur in the U.S.

“It can range from a relatively mild disease to a deadly one,” Claborn says. “In recent years, physicians have noticed a polio-like paralysis associated with prior infections with West Nile virus.”

Ticks are most notable for spreading Lyme disease, primarily in the northwest and north-central parts of the United States, though it can occur elsewhere, Claborn says. Ticks also can spread related organisms and chronic infections that can create a slew of other complications. And there is a “very infectious” bacterial disease known as tularemia in the Ozarks of Missouri spread by ticks, horse flies and mosquitos. There are many other insects that can spread diseases, Claborn says.

Topical anti-itch sprays with Benadryl are “often helpful” for itching, Claborn says of anyone who becomes the victim of insects. A menthol powder may be needed for relief of stings like those of fire ants, though, he says. Calamine lotion also can provide sting relief. Aspirin and ice packs are good for swelling.

“Avoid hot showers or hot baths,” Claborn cautions. “It makes the itching much worse. In fact, using water as cold as one can stand can provide some relief.”

Following mosquito bites, Claborn recommends a doctor anytime someone develops a fever, headache and/or neck pain. Medical help is also advised when a tick bite leads to a rash, especially with a clear spot in the middle, and/or fever. For stings, swelling, hives and difficulty breathing also require medical attention.

Poisonous plants

As many who have wandered off trail or cleared out a strange patch of greenery on their property have learned the hard way, plants such as poison ivy, poison oak and poison sumac can leave a lasting impression — typically, a rash that can be spread if not properly addressed.

But Joe Boggs, an assistant professor of entomology and horticulture expert with Ohio State University, says the dangers of touching something problematic are not as great as some people think.

“Those would be the big three,” Boggs says of the aforementioned plants. “The fear of touching something is not that great. The plants that can give you rashes are minimal. There aren’t that many.”

Even those three tend only to be prevalent in certain regions. And where they are, people often pass down the rules well. Identification is the best defense against those plants, Boggs says.

“We all learn about ‘leaves of three, let it be,’” he says. “We all learn about poison ivy early on. The same actually applies to poison oak. Poison sumac is a little trickier, but even then, where poison sumac exists, people learn not to touch that plant.”

All three of those transfer a substance called urushiol, an oily compound that spreads the plants’ rash-inducing defense mechanisms. Boggs recommends whenever people get in from a walk that involves vegetation to change and clean up well.

“You should wash up,” Boggs says. “Soap and water will take off urushiol. That’s the first thing people should do. Good old soap and water — that’s the first line of defense.”

In the event that someone suffers a rash, Boggs says there are plenty of over-the-counter medications that can help, and in many cases there is not much a physician can do beyond what people can do for themselves. Though, he offers the caveat that sensitivity can vary quite a bit by person.

“Sometimes, we don’t go to a doctor when we should,” Boggs says. “I think it should be in the cards that people seek medical attention rather than handling it themselves.”

Boggs also cautions against one major emerging threat — wild parsnip. While taxonomically it is the same as parsnip grown in one’s garden, the wild version has a compound in the sap that can create major problems for anyone who makes skin contact with it.

“Wild parsnip does much more than cause a rash,” Boggs says. “The reaction between the sap and sunlight produces severe skin blistering. There have been cases requiring skin grafts.”

But beyond that, Boggs says there are still “far more” plants that are poisonous than those that create rashes. The solution may seem — and to some degrees is — simple.

“Do not eat plants that you do not know,” Boggs says. “That is extremely important. Certainly don’t eat mushrooms. Don’t eat anything where you don’t have an expert telling you you can eat it. Don’t say ‘That looks a lot like —’ That’s like the famous last words.”

Still, people die from eating the wrong plants, such as poison hemlock.

“It is one of our most toxic plants in North America,” Boggs says. “People have died from accidental poisonings. Accidentally ingesting any part of the plant, from sap to roots to seed, means a trip to the emergency room.”