(February 2011) by Dr Clinton Anderson

I make no apology if the topics of sunburn and heat stroke/exhaustion have been covered before. After recent experience, I cannot help but think that the dangers surrounding these issues warrant repeating. The first incident refers to a patient, who embarked on a fishing trip at midday. He discarded his clothing, except for a pair of shorts, and did not apply sunscreen. He claims his exposure was less than an hour. By the time he saw me, he had 70% of his surface area covered with partial thickness burns. The second incident occurred whilst watching a cricket match. Temperatures rose to 30 degrees. While most spectators were sensible, there was a group who insisted on getting completely drunk. They stripped down to the minimum, did not apply sunscreen and ran riot, working up a sweat, and then quenched their thirst with more beer! This is heat stroke/exhaustion "waiting for a place to happen".

Firstly, sunburn. Let's dispense with the technicalities of ray- and skin- types, distance from the equator, holes in the ozone, etc. The best approach is to prevent it. The bottom line is, fair, ginger or dark - avoid the sun between 10/11am-2pm. Wear protective clothing, including a hat, preferably broad-brimmed (staying cool is more important than looking cool); seek shade where possible; apply sunscreen with a minimum protection factor of 30 and do so repeatedly whether the product claims to be water-resistant or not; there may be merit in preventatively taking a tablet containing Polypodium leucotomos. This is a tropical fern extract marketed in New Zealand as Heliocare(R). The latter contains additional anti-oxidants, green tea extract and beta-carotene. This should not replace the former-mentioned measures but rather be used in addition. Please read about safety issues in pregnancy and under-18s. If sunburn is incurred - keep cool with light clothing; cool water will soothe; keep up a good fluid intake (non-alcoholic); aloe vera topically may help; and oral pain relievers have a place if topicals are inadequate. Consult a healthcare professional if none of the above suffices.

Heat stroke/exhaustion is also best prevented. Technically, there are some differences between the two, but I don't want to delve into that here. In essence, whether by exposure to excessive heat with or without physical activity - it boils down to an uncontrollable rise in the core temperature of the body (above 38°C), manifesting as a red, hot and dry patient, possibly dizzy or light-headed, dehydrated, nauseous or vomiting, and possibly confused or disorientated. If unattended and in severe cases, seizures (especially in children), coma and even death may follow. So! Avoid excessive heat. More specifically, avoid physical exertion in excessive heat. Be aware that heat AND humidity is a dangerous combination in that the normal cooling mechanism of sweat-evaporation is diminished. Furthermore, take note that certain medications may inhibit that part of the nervous system essential in aiding cooling. For example, anti-spasmodics, some inhalers (tiotropium and ipratropium), central nervous system medications (Parkinsons disease) and antihistamines. Some natural products may also have this effect eg Belladonna, Henbane, Mandrake, and Deadly Nightshade. Be sure to replace fluid loss more aggressively in extreme heat even without activity. If one does suffer from heat stroke/exhaustion, cool down by stripping to a minimum of clothing, apply cooled wraps, sponging, or immerse in cool water and use fans to assist evaporation. Continue to aggressively rehydrate. Do not immerse in icy water as this is potentially harmful. Do not use drugs traditionally used to treat fever since they are ineffective and may do harm (eg paracetamol, anti-inflammatories). If there is no improvement, confusion or altered state of consciousness, seek urgent medical attention.

Stay Cool!