Skin reacts and swells badly after being in the sun

Dear Dr. Roach: I am not a sun worshipper. Whenever I go out, I cover up, slather on sunscreen, and stay in the shade. Last summer, I took a trip to the beach. I slathered up and stayed in the shade for about an hour. I went for a short swim, came back in, then rested in the shade. On the walk home, my face and eyes started to swell. By morning, my right eye was all puffed up. The next day, both my arms broke out in a nasty rash. After three days and a full jar of my eczema cream, I finally beat it back.A month later, it happened again. After a couple hours in the shade, the bags under my eyes swelled up. It went away, but now I feel tingling and itchiness all over my face. My eyelids, nose, nostrils, cheeks and hairline are all tingly and itchy, like a spider is crawling across my face. It's not a sunburn, and there is no rash. What is going on? — A.P.Answer: There are a large number of photosensitivity reactions. The most common is called polymorphous light eruption, sometimes called sun poisoning or a sun allergy. However, there is a characteristic rash that can occur within hours, or sometimes days later.Photoallergy is a condition where the person becomes allergic to a component of a cream or spray. The light changes the compound, so they only develop the allergy after exposure to the sun. Sunscreens, fragrances and topical anti-inflammatories can all do this. There is a rare condition called solar angioedema, which is severe swelling after exposure to the sun. People with this condition universally described intense stinging.It is difficult to diagnose skin disorders without seeing them, especially when one isn't a dermatologist, so I strongly urge you to see one. Some sun reactions can be made worse by prescription medications. Be sure to go over any medicines you are taking.Dear Dr. Roach: I am a 64-year-old woman who either walks or jogs daily. I noticed lately that my joints are stiffer, and I have more aches and pains in my joints. I talked to my primary physician, and she suggested flexibility and strength-training exercises. These have helped, but I continue to have aches.I would like to see a specialist, but I am not sure who to go to. Should I see a rheumatologist or an orthopedic doctor? Or should I just stick with my primary care doctor? — Y.W.Answer: If your goal is to get a diagnosis made, then any of your doctors can complete a set of X-rays to make the diagnosis, which sounds like osteoarthritis to me. Over 50% of people over 65 have physician-diagnosed arthritis, and a sizeable proportion of the rest will have arthritis that hasn't been diagnosed. Of course, there are other possibilities that an expert — an orthopedic surgeon, a rheumatologist or a physiatrist — would be able to diagnose.If your goal is to get additional treatment beyond the exercise that your primary care physician recommended, then I'd continue with this doctor, who might recommend an anti-inflammatory medicine, either by mouth or as a topical gel. In addition, your primary care physician knows your other conditions the best. If your symptoms become so severe that additional treatments are considered, then they can refer you to the appropriate expert.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.