Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Summer Tips: Sunburn, Blisters, Sprains, Bug Bites and More

I was recently invited by Revolution Health to offer their readers a few summer safety tips to beat the "silent summer spoilers." The following is a modified version of what was presented, with the notation that these afflictions are not so silent, and can certainly ruin your vacation or outdoor adventure.


Sunburn can be brutal. The best way to avoid sunburn is to stay out of direct sunlight. If possible, stay in the shade, and wear sun-protective clothing. Use a sunblock that is effective against both ultraviolet A (UVA) and UVB rays. It is an increasingly prevailing opinion that UVA is more damaging than previously thought. 

Be certain to obtain a good application (at least an ounce or two for a "normal" sized adult), and reapply the sunscreen often, particularly if you are sweating or spending time in the water (scuba diving, surfing, swimming, etc.). If you are taking medication, know if it might make your skin more sensitive to sunlight.

Pay attention to your surroundings. High altitude, wind, and sun reflecting off the surface of water, sand, or gravel add to UV exposure. Don't forget to protect your eyes with sunglasses rated to block nearly 100% of UV radiation. If you decide to use insect repellent containing DEET (N,N-diethyl-m-toluamide) as well as a sunscreen, be advised that the combination might reduce the effectiveness of the sunscreen. If you are using two separate products (sunscreen and insect repellen), in general, it is best to apply the sunscreen first, allow it to absorb into the skin for 20 to 30 minutes, then apply the insect repellent, in order to maximize the effect of the repellent. If you are going to be in water where you might come in contact with stinging jellyfish, consider using Safe Sea sunblock with jellyfish sting protective lotion incorporated into the product.

A mild sunburn without blistering can be treated with cool compresses, showers or baths, a non-sensitizing skin moisturizer lotion, and aspirin or a nonsteroidal anti-inflammatory drug (e.g., ibuprofen) to decrease inflammation. A sunburn, even first degree, that is so extensive that it causes the victim to suffer chills, nausea and vomiting, weakness, and diarrhea, may require oral rehydration and bedrest. If blisters are present, this indicates second-degree burns, which sometimes must be treated with topical antiseptic ointment, bandages, and more extensive medical care. You certainly wish to avoid this situation. The skin bubbling and peeling that follow a first degree sunburn are superficial and do not result in fluid loss, and rarely lead to infection, but the skin should be kept clean and moisturized to prevent any complications. Anyone with a severe sunburn of any sort should be examined for dehydration.


Blisters are the bane of hikers and trekkers, and often of persons wearing new sandals, particularly if the feet are dirty and dusty, as the grit and grime serve as agents of abrasion. Break in andy new shoes, boots, flip-flops and sandals before walking any distance in them. Keep your feet clean and dry. When walking in boots, wear a thin pair of liner socks under your regular socks, so that the friction is between the socks, not between the boots and your feet. Cushion any reddened "hot spot" or cover it with a BlistOBan® bandage before a fluid-filled blister appears. If you do get a blister:

Fasten a "donut"-shaped foam pad to the perimeter of the affected area. Cover the affected area ("donut hole") with a fitted hydrogel (e.g., Spenco 2nd Skin®) pad, and then place tape over the foam and hydrogel. Watch for signs of infection, which include cloudy fluid or pus within the blister, or red streaks emanating from the edges of the blister into the surrounding skin. If the blister appears infected, use a disinfected or carefully cleaned needle to create a small puncture at the edge of the blister, and drain it. Cover the open wound with antiseptic ointment, and apply a sterile dressing.

Sprains and Strains

Sprains and strains are common ailments in the summertime due to increased outdoor activity. The most common sprain involves the ankle. In the event of a sprain, use the "RICE" technique. RICE stands for "rest, ice, compression, elevation." Try to rest the joint. Elevate the affected body part and apply ice packs intermittently (e.g., 15 minutes on, 15 minutes off) as much as is practical for the next 24 hours. If the skin becomes reddened and painful from the application of ice, ease off to avoid a cold injury (e.g., frostbite) to the tissues. Mild compression with a wrap may provide some pain relief. If you need to keep walking, tape, bandage or splint the joint for support.

Once a joint is weakened by a strain or sprain, re-injury is common. Take precautions by using a mechanical ankle support (e.g., brace and high-top shoes or boots) and/or a walking stick over rocky terrain. It takes a full 6 to 8 weeks to recover from a mild ankle sprain, and 3 to 6 months to recover from a severe sprain.

Gastroenteric Problems

Gastroenteric problems are common in the summer. Traveler's diarrhea, commonly caused by the bacteria E. coli, is often due to water or food contamination. Failure to wash or "gel" hands or to properly prepare food are likely the most common errors that lead to diarrhea. Water disinfection techniques include heating, addition of chemicals, filtration, or application of UV light. It is important to carry redundant water disinfection systems, so that if a unit (e.g., filter) is lost or damaged, you have backup. Avoid drinking beverages with ice, unless you can be absolutely certain that the ice was prepared from properly disinfected water.

Tick and Mosquito Bites

Tick and mosquito bites can result in serious, even fatal, infections. So, be certain to protect yourself. If circumstances permit, wear light-colored pants tucked into socks and paired with a long sleeve shirt. Wear a head net or use a bed net when needed. Use insect repellent(s). Permethrin is applied to clothing, while DEET or picaridin is applied to exposed skin. Perform regular "tick checks" of the entire body (especially the scalp, groin and armpits), and immediately remove ticks. When attempting to remove a tick, do not twist it, touch it with a hot object such as a hot match head, or attempt to suffocate or kill it with petrolatum (petroleum jelly), mineral oil, kerosene, stove fuel, etc. These techniques might cause the tick to struggle and regurgitate potentially infectious agents into your bloodstream. 

Poison Ivy, Oak, and Sumac

Finally, learn to recognize poison ivy, oak, and sumac. If you become exposed to their resin, immediately wash it off with soap and water or with a specialized scrub (e.g., Tecnu or Zanfel) within 30 minutes if possible. To treat a rash from poison ivy, oak or sumac, you may soothe the affected skin with calamine lotion and also consider the following measures: apply a topical anesthetic, such as praxomine HCl 1%; soak in a tepid (not hot) bath supplemented with baking soda or Aveeno (contains oatmeal proteins); consider taking an antihistamine medication, which helps control itching and acts as a sedative. Consult a physician if the reaction is severe. Prescription treatment (such as corticosteroid therapy) may be required. 

The resins from plants can remain on clothes, fabrics, backpacks, tents, pet fur and elsewhere for long periods of time, so be certain to wash these carefully to prevent further exposure to the resin. Once the rash appears, you are not contagious, and you cannot spread the rash by scratching. However, you can open up blisters and make the affected skin vulnerable to secondary infection.

image courtesy of

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Tags: Bites & Stings , Hot & Cold , Staying Safe

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.