Extreme Heat Waves, Going to the Beach, and Plaquenil

It's summer. Of course, Florida is hot during this time of the year, but this past week was one of the hottest I can remember since living in the Panhandle.

Summer heat with RA

Waking up each day and checking the weather for the newly updated high temperature for the day become treacherous: 93 one day (not too bad at all, fairly normal for this time of year); 96 the next day (starting to get worse...); 100 the following day, 103 the next, 104 the next, 102 the next, etc. You see the pattern. And don't forget the high humidity that accompanies any weather in Florida, sometimes topping out at 50% humidity even during the peak of the day.

All of this to say: it's hot, and it wasn't until this heat wave that I realized how much heat can impact RA and other chronic illnesses, although not in the way you may expect. For this article, I want to discuss how I've been dealing with the heat and how the sweltering heat impacts my RA and lupus co-diagnoses.

Plaquenil and sun exposure

First, most of this happened after I visited the eye doctor for my regularly scheduled eye exam. As I've mentioned before in some previous articles, I take Plaquenil for RA and lupus. My eye doctor mentioned that Plaquenil could cause serious skin sensitivity when you're in the sun. The sensitivity can manifest in a myriad of ways.

It can bring back the malar (butterfly) rash that is associated with lupus but make it more bumpy and painful than before. The sensitivity can also make you feel drowsy and more tired than usual, and with a quicker onset to complete those complications. I had heard of these sensitivities before but hadn't fully listened to their explanation or why it was important to consider.

My beach trip didn't go as planned

That is until I went to the beach one weekend to have a vacation by myself. I went to Rosemary Beach, FL, a beautiful albeit expensive small beach town on the Gulf Coast of Florida. It was wonderful, and I did have a great time, but the vacation ended up being shorter than I had wanted it to be. I was so tired just even being on the beach for 10 minutes. I felt drained, exhausted, and just wanted to go home.

I had experienced something like this previously when it was a little warmer, but I didn't know why. I just had this feeling of not wanting to do anything and as if I were to pass out just by being on the beach. And to note: this wasn't heat exhaustion because I had plenty of water, had an umbrella over me, and was sitting on the beach for only 10 minutes.

Photosensitivity from RA medications

Considering what my eye doctor told me about my recent beach vacation, I decided to research sun exposure and Plaquenil. The Skin Cancer Foundation published an article in 2020 about medications that can specifically make your eyes more sensitive to the sun.

They write: "Hydroxychloroquine, for example, is one medication that can cause significant sun sensitivity in the eyes. This drug is used primarily to prevent or treat malaria but has also gained traction as a treatment for unresponsive cases of certain autoimmune diseases... patients who take hydroxychloroquine may experience light sensitivity along with other vision changes, and the likelihood of experiencing these side effects goes up if the patient is using the medication long-term."¹

In addition, the Arthritis Foundation published an article specifically about arthritis medications and sun sensitivity where they go into a little more depth about the type of sensitivities that may occur when taking Plaquenil. For instance, "There are two types of photosensitive reactions: phototoxic and photoallergic. In a phototoxic reaction, the medication is activated by UV radiation, causing damage to the skin that can look and feel like a sunburn. Phototoxic reactions generally happen within 24 hours and are usually limited to exposed skin."²

Staying out of the sun may be the best

And there are plenty of more articles about this correlation, but it's clear that there is some intersection here. So, what can you do about it? My doctor told me that the best form of protection is to limit exposure to the sun, but if this isn't possible, wearing sunglasses, a wide-brimmed hat, and light sleeves to cover your skin are the best ways to prevent side effects from Plaquenil. Sounds easy enough, but the consensus is that staying out of the sun is your best bet. I live in Florida, so armed with my sunglasses and hats, I feel better about hitting the beach during the summer, even when there's an excessive heat wave.