Jennifer Dunlavy, MD, is a board-certified emergency medicine physician with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Tysons Corner Medical Center.
Summer is a wonderful time to enjoy the outdoors, but it also brings unique health risks. Each year, urgent care centers and emergency departments see a rise in heat-related illnesses, severe sunburns, and insect bites. As a board-certified emergency medicine physician at Kaiser Permanente, I regularly care for patients with these common — and often preventable — conditions. By taking a few simple precautions and recognizing early warning signs, you can stay healthy and make the most of the season.
What Are Heat Exhaustion and Heat Stroke?
Heat exhaustion and heat stroke happen when your body gets too hot and can’t cool itself effectively. They are most likely to occur when you spend too much time in the heat without drinking enough fluids or giving your body time to adjust to hot weather. Activities like exercising, hiking, or yard work can increase your risk.
Heat exhaustion is a milder form of heat illness. Symptoms include heavy sweating, weakness, dizziness, headache, nausea, and muscle cramps. If these symptoms develop, move to a cool place, drink fluids if you are awake and alert, and rest. Most people recover with these measures.
Heat stroke is a medical emergency. Heat stroke happens when the body’s temperature becomes dangerously high and the brain begins to be affected. The most important sign is a change in mental status, such as confusion, unusual behavior, slurred speech, seizures, or loss of consciousness. The person’s skin may be hot, and they may or may not be sweating.
If you suspect heat stroke, call 911 immediately. While waiting for emergency help, move the person to a cool place, remove excess clothing, and begin cooling them with cold water, ice packs, or cool wet towels.
Heat exhaustion should never be ignored. Without prompt treatment, it can progress to heat stroke, which can be life-threatening.
Sunburn, Sun Poisoning, and Margarita Burn: What’s the Difference?
Despite its name, “sun poisoning” is not a medical diagnosis. People commonly use this term to describe one of two different conditions: a severe sunburn or a sun-related rash.
Most commonly, “sun poisoning” refers to a severe sunburn. In these cases, the skin is very painful, red, and inflamed. A severe sunburn can also affect your entire body, causing fever, chills, headache, nausea, dehydration, fatigue, and sometimes vomiting—making you feel as though you have the flu.
Less commonly, people use the term “sun poisoning” to describe a rash caused by an immune system reaction to sunlight. The most common of these rashes is called polymorphous light eruption (PMLE). It usually develops several hours to a few days after sun exposure as an itchy, bumpy rash on sun-exposed areas such as the arms, chest, or legs. Unlike a sunburn, PMLE is usually more itchy than painful and generally does not cause flu-like symptoms. The rash often lasts several days before gradually going away.
Phytophotodermatitis, sometimes called “margarita burn,” is a skin reaction that occurs when certain plants or fruits contact your skin before sun exposure. The name margarita burn comes from the classic scenario of squeezing limes into a margarita on a sunny day.
Common triggers include limes, lemons, celery, and wild parsnip. Chemicals in these plants are activated by sunlight, causing skin irritation.
Symptoms usually begin about 24 hours after sun exposure and may include redness, swelling, blisters, and pain. As the skin heals, it often leaves behind dark patches that can last for weeks or even months. The rash often appears in unusual shapes or streaks that match where the plant or fruit touched the skin.
The best way to protect your skin from sunburn and other sun-related skin reactions is to use several strategies together:
- Stay out of the sun during the strongest UV hours, usually between 10:00 a.m. and 4:00 p.m.
- Wear protective clothing, including long sleeves, long pants, a wide-brimmed hat, and UV-blocking sunglasses.
- Apply a broad-spectrum sunscreen with at least SPF 30. SPF 50 provides slightly more protection than SPF 30 and offers a little extra margin since most people do not apply enough sunscreen.
No matter which SPF you choose, the most important steps are to apply enough sunscreen and reapply it every two hours while outdoors, or sooner if you are swimming or sweating.
See a doctor if you develop severe blistering, signs of dehydration, fever that does not improve, confusion, or a rash that is widespread, keeps returning, or is getting worse.
When to Seek Treatment: Bug Bites and Tick Bites
It can be difficult to tell the difference between a normal reaction to a bug bite and a skin infection because they can look and feel very similar, especially during the first few days. Most insect bites cause an inflammatory reaction that begins within minutes to hours after the bite. For mosquitoes and many other insects, symptoms usually improve over the next day or two. Stinging insects, such as bees and wasps, can cause larger local reactions that peak after one to two days and may last three to ten days. During this time, it is normal for the area to be red, swollen, itchy, warm, and tender.
The bite should gradually improve over the next few days. See a doctor if the redness or swelling continues to spread, the pain is getting worse, you develop a fever, pus or yellow crust forms at the bite, or you notice red streaks spreading up your arm or leg. These may be signs of a skin infection that needs treatment.
The best way to protect yourself from mosquitoes, ticks, and other biting insects is to combine three strategies: avoid peak exposure times, wear protective clothing, and use bug spray.
Look for an EPA-registered insect repellent containing one of these active ingredients:
- DEET (20–30%) protects for about 4–6 hours and is safe for children 2 months and older.
- Picaridin (20%) provides similar protection, may last even longer (up to 8–10 hours), feels lighter on the skin, and does not damage clothing.
- Oil of Lemon Eucalyptus (OLE) is a plant-based option that provides up to 6 hours of protection but should not be used in children younger than 3 years.
For extra tick protection, consider permethrin-treated clothing – it kills ticks on contact and lasts through many washes. Never apply permethrin to the skin.
If you find a tick attached to your skin, remove it as soon as possible using fine-tipped tweezers. Grasp the tick close to the skin and pull upward with steady, even pressure. Do not twist, crush, or burn the tick. Wash the area with soap and water afterward. Removing a tick promptly reduces the chance of disease transmission.
Tick bites can be more complicated than other insect bites given the diseases they carry, with Lyme disease being the most common. After a tick bite, there are two times you should see a doctor:
- Within 72 hours if the bite may be high risk for Lyme disease and you may benefit from preventive antibiotics.
- Within the next 30 days if you develop symptoms of a tick-borne illness.
The Infectious Diseases Society of America (IDSA) recommends a single dose of doxycycline, for children and adults, within 72 hours of tick removal for high-risk bites. A bite is considered high risk only if:
- The tick was likely a blacklegged (deer) tick (Ixodes), the type of tick that spreads Lyme disease in the United States.
- The bite occurred in a Lyme-endemic area.
- The tick was attached for 36 hours or more and was removed within the last 72 hours.
If it is not clear that the tick was a blacklegged (deer) tick or how long it was attached, preventive antibiotics usually are not recommended. Instead, watch for symptoms over the next 30 days.
Regardless of whether prophylaxis was given, medical evaluation is warranted if warning signs or symptoms develop within 30 days of a tick bite in an endemic area.
Symptoms of Lyme disease may include:
- A rash that slowly gets larger over several days. It may have a bull’s-eye appearance, but many Lyme rashes do not. The rash usually appears three to 30 days after the bite.
- Fever, chills, headache, muscle aches
- Joint pain or swelling
Seek urgent medical attention if you develop:
- Facial droop (Bell’s palsy)
- Chest pain, palpitations, or fainting — these uncommon but serious signs of Lyme carditis
Remember, Lyme disease is not the only illness that ticks can spread. Tick-borne illnesses may not cause symptoms for days or even weeks after a bite. If you develop a rash, fever, severe headache, muscle aches, or other unexplained symptoms, see your doctor. Early diagnosis and treatment can help prevent more serious illness.
Summer offers countless opportunities to spend time outdoors, but it also brings unique health risks. Fortunately, many of these are preventable. Taking a few simple precautions, recognizing early warning signs, and seeking medical care when needed can help you stay safe and enjoy everything the season has to offer.
Feature image, stock.adobe.com
