Can the sun and UV/phototherapy help TSW skin?

Note: Reading the first article on how topical steroids affect our skin may help in understanding the information below.

How does sun and UV/phototherapy help eczema?

Sunlight and UV/phototherapy works by reducing your skin’s immune response and therefore reducing inflammation on your skin. In a sense, UV radiation has some immunosuppressive effects on the skin. This is helpful for eczema or psoriasis.

Can sunlight and UV/phototherapy help TSW skin?

While there are benefits of UV therapy and sunlight for eczema and psoriasis, the benefits for TSW skin are a little contentious. TSW skin is very different from any other skin condition that benefits from immunosuppression. Thus the usage of UV therapy in TSW should be done carefully.

TSW skin is thinned skin from steroid use. Hence is can be very delicate, and more susceptible to UV damage than normal skin. UV rays can easily penetrate thinned TSW skin and cause burning and damage; the heat from the UV rays can also cause irritation and a flare up. When introduced at the wrong time, people with TSW skin can experience a flare up after a UV therapy session - some report extreme redness, burning and pain.

UV therapy is more suited for TSW skin that is in the later stages of healing, when the skin is no longer open or flaky but just thin. In these cases, some sunlight can help with healing. The right amount of sunlight is important - too much can still cause a flare. Even when the skin is at a good stage, prolonged periods of exposure is not recommended. A good guideline is sunbathing in the morning or evening right before the sun sets and limiting your exposure to 30 mins.

The combination of sunlight and salt water has some impressive immunosuppressive healing properties and this is why many with skin conditions benefit from living near the sea. Again, this is suitable if your skin is in the last stages. Soaking in a clean sea in short bursts of 10mins helps with killing infections and closing any wounds. An early morning or evening soak when the sun is rising/setting is recommended.

Some TSW doctors or practitioners such as Dr. Sato and Jay discourage sun exposure because most TSW patients overexpose themselves to it and end up in a flare. It can be tricky to determine the right stage to introduce it and to determine exactly how much your skin can handle at any given moment. While the skin is not ready, avoiding the sun is highly recommended.

How to protect yourself from the sun

When your skin is still recovering, avoiding the sun is more beneficial than staying under it.

1) Bring an umbrella wherever you go. I use an umbrella with silver/black lining on the underside which helps to block out UV rays more effectively

2) When you are doing outdoor activities, wear sun sleeves, a hat and sunglasses

3) Sunscreens are always good for healthy skin. But TSW skin generally gets irritated by sunscreen. Most sunscreens have moisturising ingredients in them too, which cause elephant/hardened skin. Thus using sunscreens regularly is not recommended.

If you must use a sunscreen, choose a physical sunscreen instead of a chemical one. Physical sunscreens provide a layer of protection on your skin by literally physically shading the skin from the sun, while chemical sunscreens absorb UV radiation via chemical bonds. Physical sunscreens usually sit on top of the skin layer to protect it while chemical sunscreens require chemical reactions within the skin’s layer to protect it - this usually irritates TSW Skin.

You can tell the type of sunscreen from the ingredients on the bottle: the active ingredients for physical sunscreens are zinc oxide or titanium dioxide, while chemical sunscreens typically contain avobenzone or oxybenzone.