by Dr Valerie Milne

The interaction of inflammatory arthritis (such as rheumatoid arthritis, psoriatic arthritis and other forms of spondyloarthritis), medications to control arthritis and sun sensitivity is not always clear, and the reactions between medications and sun vary;

sunglasses and hat

  • NSAIDs, such as Naproxen and diclofenac, can make you more sun sensitive as can Sulfasalazine/ Salazopyrin. Hydroxychloroquine can increase light sensitivity and vision changes.
  • COX-2 inhibitors like Celecoxib can cause irritation, with a breakout in rashes, but there is some trial evidence they may slightly reduce the risk of non-melanoma skin cancers (however, other serious side effects need to be considered before any use of COX-2 inhibitors for sun protection).
  • There is an increased risk of non-melanoma skin cancers (NMSC) for people being treated with DMARDs such as methotrexate and some biologic therapies. These medications also increase the risk of NMSC recurrence.
  • Methotrexate can irritate the skin where sunburn has occurred previously (and let’s face it, that’s highly likely for many, especially older New Zealanders).
  • Long-term corticosteroids thins the skin, making it more likely to burn, and more susceptible to wrinkling and thinning of the skin (skin atrophy).

It’s not news to most New Zealanders that our UV rays are higher than other countries at similar latitudes. To make matters worse, this year UV levels are 5-10% higher than usual. Maximum levels are now 11+ and at this level the UV Index recommendation is to seek shade between 10 am and 6 pm, wear sun-protective clothing, use a high-protection sunscreen and reapply regularly to prevent burning.

Damage to unprotected fair skin can occur in less than 15 minutes when the UV Index is 12, and within approximately 60 minutes when UVI is 3. But fair-skinned people are not the only ones at risk of sun damage that can cause skin damage. Other skin types may have a little more time before damage occurs, but few people are exempt from risk, and it’s easy to forget that the long, sunny summer days can play havoc with the skin of people living with arthritis who are taking medications to control their disease.

If you are at high risk, or otherwise concerned about the risk of sun sensitivity, discuss this with your rheumatologist. Sunscreen

For people taking medications for arthritis, especially disease-modifying drugs to suppress inflammatory arthritis conditions, it is more important than ever to check your skin regularly for changes to moles or freckles. Even if your spot doesn’t seem to be very much, you don’t know what is going on underneath that top layer of skin. See your doctor if you notice any changes or if you are at high risk of skin damage; add a dermatologist to your healthcare team for regular checks. Early detection, topical treatments and removal are the best and least invasive approaches for treating these skin lesions. See Skin cancer | Healthify for more information.

Prevention is the obvious choice for sun sensitivity and reactions to the sunlight. Please do follow the SunSmart guides, check your weather app and reduce sun exposure when UV is high and in town, at the beach or on the farm or anywhere else where you’re working, playing or just relaxing in our great outdoors – cover-up, be a shade-seeker, slop on sunscreen (replacing regularly), slap on a hat and wrap on some sunglasses.

Note: Overseas websites may advise using sunscreens with lower UV protection than is advised in New Zealand – check the SunSmart website for recommendations.

Characteristics of sun reactions

Photosensitivity reactions often look and feel like sunburn. They can leave sun-exposed skin with a rash, redness, swelling, blisters, red bumps or oozing lesions. Severe cases can cause secondary skin infections.

Photosensitivity reactions fall into two categories: phototoxic reactions and photoallergic reactions.

In phototoxic reactions, a drug is activated by exposure to UV light and causes damage to the skin that can look and feel like a sunburn or a rash. These reactions can happen within minutes or after hours of exposure and are usually limited to the skin that has been exposed.

Photoallergic reactions occur when UV rays interact with the ingredients in medicines or other products applied directly to the skin. The body’s immune system recognises changes caused by sun exposure as a foreign threat. The body produces antibodies and attacks, causing a reaction.

These reactions are distinct from “recall” reactions, where radiation-induced dermatitis and sunburn can reappear on re-exposure to radiation and sunlight while on methotrexate therapy.

More Information

The UV Index gives a measure of the strength of the Sun’s rays.

Low 1-2 generally safe to be outdoors unprotected unless spending a lot of time outside
Moderate 3-5  
High 6-7  
Very High 8-10  
Extreme 11+  

UV index

The UVI also depends on the ozone amount, sun angle, the sun-earth separation, altitude, pollution, and surface reflections (e.g., snow cover).

Because of differences in ozone, sun-earth separation, and pollution, the peak UVI in NZ is approximately 40% greater than at comparable latitudes in the Northern Hemisphere.

The UV index is available as part of the NIWA Weather App.


Be safe—Be SunSmart. (2021, December 1). SunSmart.

Liu, R., Wan, Q., Zhao, R., Xiao, H., Cen, Y., & Xu, X. (2021). Risk of non-melanoma skin cancer with biological therapy in common inflammatory diseases: A systemic review and meta-analysis. Cancer Cell International, 21(1), 614.

Medications and Sun Sensitivity. (n.d.). Pain Scale. Retrieved 15 December 2023, from

Medicines and Healthcare products Regulatory Agency. (n.d.). Methotrexate: Advise patients to take precautions in the sun to avoid photosensitivity reactions. GOV.UK. Retrieved 15 December 2023, from

Skin cancer. (2022, August 3). Healthify.

Sulfasalazine (Azulfidine). (n.d.). American College of Rheumatology. Retrieved 15 December 2023, from

Venosa, A. (2020, August 25). Is Your Medication Making Your Eyes Sensitive to the Sun? The Skin Cancer Foundation.

Wheatman Hill, L. W. (2023, July 10). Does prednisone cause sun sensitivity? The Checkup.

Widely Used Arthritis Pill Protects Against Skin Cancer. (n.d.). URMC Newsroom. Retrieved 15 December 2023, from

Translate »