SKIN CARE, INSECT BITES AND STINGS

Sun

The closer you get to the Equator, the more intense sunlight
becomes. Sunbathing in the tropics has to be done in
moderation. Protective clothing and hats are recommended.
Apply sun cream with high sun protection factor (30 or more)
to exposed skin regularly (every two hours) and carefully.
Apply sun cream after bathing and avoid long water exposure
since sun stroke will be imminent in spite of reduced heat
feeling. Avoid perfumed sun creams and check whether or
not used creams or medication can cause "sun allergy"
(photo-toxic or photo-allergic reactions).

We would like to refer to point 5 of the European cancer
code: avoid excessive exposure to sun and sunburn during
childhood (increased risk of melanomas in later life). Do not
take a course of sunbed sessions before going on holiday as
the sun tan obtained through UV-A does not give any extra
protection against the natural UV-rays.

When using sun creams and insect repellents based on DEET,
recent studies have shown that DEET reduces the
effectiveness of the sun cream, but that sun creams do not
have a negative influence on the effectiveness of DEET. It is
advisable, therefore, to apply the insect repellent (DEET or
another repellent) with the sun lotion and then to take
additional precautions to protect against UV (e.g. a sun cream
with a higher protection factor).

Light sunburn heals spontaneously. A cold shower can
provide relief. Common after-sun or rich creams are often
not enough in cases of real burns. It may be necessary to locally
apply a cortisone cream (preferably after consultation with a
doctor).

Sunstroke is a distinct extensive type of burn due to
prolonged exposure to the sun.

Prickly heat (miliaria rubra) is a frequent problem in
warm and humid regions. It is an intensely itchy rash caused
by blockage of the sweat ducts by dead skin cells. More sweat
leads to a swelling of the sweat gland channels and sweat
retention vesicles which in turn can lead to a skin rash local
inflammation. Usually there are only a few red “pearls” visible,
mainly in body folds around the waist and on the shoulders.
It mainly affects small children. The only remedy is regular
cold showers (preferably without soap), keeping the skin dry
with menthol talcum powder, and wearing light cotton clothing.
For the itching (and the additional infection caused by
scratching) antihistamines (anti allergy tablets) can be taken.

Wound infections are a frequent and often underestimated
problem for travellers to developing countries. Insect bites that
have been scratched open or untreated wounds and injuries are
frequent. Minor wounds on the lower leg or the foot nearly always
get infected (contamination with bacteria); particularly if no
special attention is paid to them.

We cannot emphasise strongly enough that any wound, however
minor, should be carefully cleaned, washed and disinfected. It is
not unusual for an infected wound to take many weeks to heal,
even with good care upon return from a trip.

A powerful antiseptic ointment1 is thus a vital component in the
most basic home medicine kit. Mercurochrome is totally
unsatisfactory as an antiseptic. A common mistake is to use
volatile antiseptics (such as alcohol), which do not provide any
long-lasting disinfection. The conventional adhesive plaster strip
often does not give enough protection, and is not advised for
foot wounds. An antiseptic cream or ointment (remains longer)
preferably covered by a sterile gauze, should be changed once
or twice daily (great caution is advised when using it on
sun-exposed skin, as photosensitization is very common!). The
premature formation of a scab can still allow the wound to fester,
which in turn delays the healing process.

Only when the wound has become relatively painless can a scab
be left alone. If the wound further develops in spite of good local
care, and certainly if the inflammation and swelling around it
increase, there should be no hesitation in starting a suitable
antibiotic treatment (penicillinase-resistant penicillin such as
oxacillin, cloxacillin, dicloxacillin and flucloxacillin) . If there is a
wound on the leg, it is advisable to rest with the leg up. It is
well worth going over these points during a travel consultation,
especially for people who are travelling for a long period in
primitive conditions.

In warm and humid areas the variety and number of insects is
enormous. Mosquitoes, flies and other biting insects can cause
a great deal of discomfort, not only because the bites
cause local reactions, but also because some insects transmit
infections, such as malaria, dengue, leishmaniasis, sleeping
sickness, etc.

Local skin reactions to insect bites usually diminish in proportion
to the length of time spent in the tropics. Some people, however,
develop hypersensitive reactions. “Culicosis bulosa” is an hyper
allergic reaction; an severely itching blister, filled with clear liquid,
appears on the site of the insect bite. Preventive measures
against mosquito and tick bites also partly apply to other insects
(repellents).

An oral antihistaminic is useful for alleviating the symptoms
of itching. Great caution is advised when using antihistamine
ointment on parts of the skin exposed to the sun, as
photosensitization is very common. Some dermatologists
recommend potent corticosteroidbased ointments for
self-treatment of bothersome allergic reactions but these
should never be applied on the face.

Read Continue To #2