Treatment of Hives from Sunscreen

Immediate Management

• The Centers for Disease Control and Prevention recommends immediately discontinuing the offending sunscreen and treating with non-sedating oral antihistamines as first-line therapy 1
• Stop using the sunscreen immediately upon development of hives, as continued exposure will perpetuate the reaction, as suggested by the British Journal of Dermatology and the Centers for Disease Control and Prevention 1, 2

First-Line Pharmacologic Treatment

• The American Academy of Dermatology recommends prescribing non-sedating H1-receptor antihistamines, such as Fexofenadine 180 mg daily, Loratadine 10 mg daily, or Cetirizine 10 mg daily, as the mainstay of therapy for sunscreen-induced urticaria 3, 4

Long-Term Management and Prevention

• The Centers for Disease Control and Prevention recommends mineral-based sunscreens containing zinc oxide or titanium dioxide for patients with confirmed allergic reactions to chemical UV filters 1
• The American Cancer Society suggests prioritizing non-sunscreen photoprotection methods, including avoiding sun exposure, seeking shade, and wearing protective clothing, as the first line of defense, and using sunscreen as a complementary measure rather than the primary protection method 1, 5
• The European Society for Medical Oncology recommends applying hypoallergenic sunscreens with high SPF (at least SPF 30, PABA-free, UVA/UVB protection) to exposed skin areas, and wearing protective clothing and hats for additional sun protection 6

Critical Pitfalls to Avoid

• The American Geriatrics Society advises against using sedating antihistamines, such as hydroxyzine or diphenhydramine, as they may predispose to dementia with long-term use, except in palliative care 3, 4
• The British Journal of Dermatology suggests not continuing to use the same sunscreen hoping the reaction will resolve, as persistent exposure will worsen sensitization 1, 2