Might outdoor heat stress be considered a proxy for the unperceivable effect of the ultraviolet-induced risk of erythema in Florence?

• We investigated the relationship between heat stress and the UV-induced risk of erythema.
• Erythemally effective UV irradiance and the Universal Thermal Climate Index were assessed.
• Heat stress was a good proxy for the UV-induced erythema in summer and some other months.
• Too many days occurred with no signs of heat stress in several months.
• Differentiated monthly alerts warning of potential UV skin damage are required.

Erythema is the most familiar short-term symptom of human skin associated with overexposure to unperceivable ultraviolet radiation (UV). However, people are able to perceive the warm infrared component of the solar radiation by means of thermal (dis)comfort. This study investigated the potentiality of perceived outdoor heat stress as a valuable proxy for the unperceivable effect of UV-induced risk of erythema in a Mediterranean city. Meteorological data and UVB (280–320 nm) measurements were obtained for the 2004–2012 period by a weather station located in the municipality of Florence. Continuous measurements of erythemally effective UV (UVEry) were performed by means of a broadband temperature-corrected radiometer with the spectral response close to the erythemal action spectrum. Hourly UVEry doses were expressed as Standard Erythemal Doses (SEDs). The newly developed Universal Thermal Climate Index (UTCI), that represents the state-of-the-art of outdoor thermal (dis)comfort evaluation, was also assessed. Descriptive analyses of the hourly distribution per month of the frequencies of days with heat stress and UVEry exceeding 2.0, 3.0, 4.5 and 6.0 SEDs were carried out based on the general skin-type characteristics. The association between UVEry and UTCI was analyzed by a two-way contingency table approach. The probability of UVEry exceeding specific SED thresholds when heat stress occurs was often significantly higher than the same probability when no heat stress is perceived. Furthermore, increased magnitudes of the ratios, ranging from the very sensitive to the minimally sensitive skin types, were also found. However, during several months, too many days occur without any signs of heat discomfort, even when people may be exposed to relevant doses of harmful UVEry for the skin of various phototypes. These findings underlie the need for public health authorities to provide differentiated advice per month in relation to potential UV skin damage in the city of Florence.