Sunburn Overview

Sunburn results from too much sun or sun-equivalent exposure. Almost everyone has been sunburned or will become sunburned at some time. Anyone who visits a beach, goes fishing, works in the yard, or simply is out in the sun can get sunburn. Improper tanning bed use is also a source of sunburn. Although seldom fatal (sun poisoning), sunburn can be disabling and cause quite a bit of discomfort.

Sunburn Causes

Sunburn is literally a burn on your skin. It is a burn from ultraviolet (UV) radiation. The consequence of this burn is inflammation of the skin. Injury can start within 30 minutes of exposure.

  • UVA and UVB refer to different wavelengths in the light spectrum. UVB is more damaging to the skin especially for skin cancer. Both UVA and UVB are responsible for photoaging (premature aging of the skin and wrinkles) and sunburn. Tanning beds produce both UVA and UVB rays.
  • Travel to the southern United States, regions close to the equator, and places at high altitudes all offer the unwary visitor an opportunity to be injured by sunburn.
  • Certain light-skinned and fair-haired people are at greater risk of sunburn injury.
  • Prior recent sun exposure and prior skin injury are risks for sunburn, even in limited exposure to the sun. However, normal limited exposure to UV radiation produces beneficial vitamin D in the skin.

Sunburn Symptoms

 

  • Mild and uncomplicated cases of sunburn usually result in minor skin redness and irritation. Untreated and with enough exposure, you can experience shock (poor circulation to vital organs) and even death (sun poisoning). Sufficient exposure can become remarkably painful.
  • Initially, your skin turns red about 2-6 hours after exposure and feels irritated. The peak effects are noted at 12-24 hours.
  • More severe cases  (sun poisoning), such as those experienced by rafters (Cuban and other island peoples fleeing their countries on homemade rafts) are complicated by severe skin burning and blistering, massive fluid loss (dehydration), electrolyte imbalance, and infection.

 

Other common symptoms include

 

    • Chills
    • Fever
    • Nausea or vomiting, or both
    • Flulike symptoms 
    • Blistering - May range from a very fine blister that is only found when you begin to "peel" to very large water-filled blisters with red, tender, raw skin underneath 
    • Skin loss - About 4-7 days after exposure

When to Seek Medical Care

If you feel your sunburn is severe enough, call your doctor. You most likely will be asked how severe your condition is and if you have any other significant health problems. The doctor can then make the decision to treat you at home or in the office or refer you to an emergency department.

Conditions that should motivate you to go to a hospital's emergency department include the following:

  • Severe pain
  • Severe blistering
  • Headache
  • Confusion
  • Nausea or vomiting
  • Fainting
  • An acute problem with another medical condition

Exams and Tests

The doctor will obtain a medical history and perform a physical examination to determine if indeed you do have sunburn and to what degree. In more severe cases, or for people with preexisting medical problems, the doctor may order certain laboratory tests to aid in determining the severity of your injury.

Sunburn Treatment

Self-Care at Home
Home care starts before a sunburn. If you are prepared before going out in the sun, you probably won't need these tips and techniques.
Immediate self-care is aimed at stopping the UV radiation.

  • Get out of the sun

  • Get out of the tanning bed

  • Relief of the discomfort becomes important.

    •  Medications such as aspirin, ibuprofen, and naproxen are useful, especially when started early.

 

For mild sunburn, cool compresses with equal parts of milk and water may suffice.

You may also use cold compresses with Burow solution. You can buy this at a drugstore. Dissolve 1 packet in 1 pint of water. Soak gauze or a soft clean cloth in it. Gently wring out the cloth and apply to the sunburned area for 15-20 minutes. Change or refresh the cloth and solution every 2-3 hours.

o Anyone raised in a beach community knows the secret of aloe-based lotions. There are many commercially available types. Ask the pharmacist at your local drugstore. Tearing apart your aloe plant in the yard and applying the cool jellylike substance inside the leaves is no longer necessary.

 

o Cool (not ice cold) baths may help. Avoid bath salts, oils, and perfumes because these may produce sensitivity reactions. Avoid scrubbing the skin or shaving the skin. Use soft towels to gently dry yourself. Don't rub. Use a light, fragrance-free skin moisturizer.

o Avoid lotions that contain topical anesthetic medications because you can become sensitized and then allergic to that medicine.

o Obviously, stay out of the sun while you are sunburned.

 

Medical Treatment

Silver sulfadiazine (1% cream, Thermazene) can be used for treatment of sunburn with appropriate cautions about use on the face.
• If your case is mild and not life threatening, the doctor may simply suggest plenty of fluids, aspirin, or other nonsteroidal anti-inflammatory medications (NSAIDs).
• Additional topical measures such as cool compresses, Burow solution soaks, or high-quality moisturizing creams and lotions may be prescribed.
• If your case is severe enough, oral steroid therapy (cortisonelike medications) may be prescribed for several days. Steroid creams placed on the skin show minimal to no benefit.
• Stronger pain-relieving medication may be prescribed in certain cases.
• If you have blistering, steroids may be withheld to avoid an increased risk of infection. If you are dehydrated or suffering from heat stress, IV fluids will be given, and you may be admitted to the hospital. People with very severe cases may be transferred to the hospital's burn unit.

Next Steps

Follow-up
Your doctor either will schedule a follow-up visit at the time of your initial evaluation and treatment or will give you instructions to return if certain problems occur. Sunburn can cause lost workdays, which in certain jobs (especially the military) can lead to disciplinary action. Furthermore, sunburn can cause premature aging and skin cancers.

Prevention

The best prevention is to avoid the sun. This is often not practical or desired many times.

• Other, more practical strategies include wearing wide-brimmed hats, long-sleeved shirts, and long pants.

• If this is not possible, a variety of sun-blocking agents are available for use.

Some are just for the lips and face. Others are for more general-purpose use. Pay attention to the sun protection factor (SPF) and whether or not PABA is in the product. PABA should be avoided in children younger than 6 months because it can cause skin irritation.

o The higher the SPF number, the more protection the sun-blocking agent may have. SPF is actually a ratio of the time it takes to produce a skin reaction on protected and unprotected skin. Thus, a 30 SPF sunscreen would in theory allow you to be exposed 30 times longer than with no sunscreen. However, this is usually not true in practice.

People seldom apply enough sunscreen or rarely reapply it. Sunscreen should be applied in generous amounts in layers and reapplied after being exposed. Activities such as sweating and swimming degrade its effectiveness. Sunscreens are not waterproof. The US Food and Drug Administration is banning what it calls misleading labeling on sunscreens. The use of the words sunblock, waterproof, and all day protection will no longer be used.

• Certain drugs can sensitize the skin to radiation injury. If you take them, avoid the sun. Your doctor or pharmacist can further advise you about your medications and sun sensitivity.

Most likely to cause sun sensitivity are antibiotics, antipsoriatics (prescribed for skin conditions), and acne medicines.

o The herbal drug, St. John's wort, is also thought to make you more vulnerable to sunburn.

• Mind-altering drugs (including alcohol) can diminish your awareness of getting sunburned and should be avoided.

Short and sequential exposure times can lead to skin pigment changes, which most of us call tanning. This can lead to increased sun tolerance but can also lead to long-term problems such as skin cancer. Getting a tan is often a primary reason people go out in the sun with maximum skin exposed in the first place. Sunburn is most common in children and younger adults.

• Avoid tanning beds entirely. Most tanning parlors make safety claims that the US Food and Drug Administration considers false.

Outlook

• Minor and uncomplicated cases of sunburn cause discomfort and no long-lasting effects. You can expect to feel better in 4-7 days. You may see skin loss or peeling. This is often associated with severe itching, especially at night, after sweating, or after showering.
• Other skin problems, such as herpes simplex, lupus, and porphyria (an inherited disorder of sensitivity to sunlight) may worsen.
• Chronic sun exposure may lead to premature aging, severe wrinkling, pigmented skin lesion development (moles), and various malignant (cancerous) skin tumors. Premature cataract formation in the eye can also result.

Synonyms and Keywords

sunburn, tanning, suntan, solar radiation burn, ultraviolet light burn, solar erythema, tanning bed overuse, UV radiation burn, sun protection factor, SPF, UVA, UVB, skin cancer, sun poisoning


Authors and Editors
Author: George Woodward, DO, FAAEM, Medical Director, St Johns County Fire Rescue: Medical Director, First Coast Technical Institute, Baptist Medical Center.

Coauthor(s): Jeffrey S Smowton, MD, FACEP, FACP, Consulting Staff, Department of Emergency Medicine, Emergency Resources Group; Clinical Faculty, Department of Emergency Medicine, University of Florida College of Medicine.

Editors: Mitchell J Goldman, DO, FAAP, FAAEM, Director of Pediatric Emergency Medicine, Emergency Medicine, St Vincent Emergency Physicians, Inc; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Jeter (Jay) Pritchard Taylor III, MD, Vice-Chief, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina.
Medically Reviewed by Melissa Conrad Stoppler, MD, Chief Medical Editor, eMedicineHealth.com

 Courtesy of  www.emedicinehealth.com 

 

 

 
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