Sunburn

A sunburn is reddening of the skin that occurs after you are exposed to the sun or other ultraviolet light.

The first signs of a sunburn may not appear for a few hours. The full effect to your skin may not appear for 24 hours or longer. Possible symptoms include:

Red, tender skin that is warm to the touch
Blisters that develop hours to days later
Severe reactions (sometimes called sun poisoning), including fever, chills, nausea, or rash
Skin peeling on sunburned areas several days after the sunburn
Symptoms of sunburn are usually temporary. But the skin damage is often permanent and can have serious long-term effects, including skin cancer. By the time the skin starts to become painful and red, the damage has been done. Pain is worst between 6 and 48 hours after sun exposure.

Causes

Sunburn results when the amount of exposure to the sun or other ultraviolet light source exceeds the ability of the melanin to protect the skin. Melanin is the skin’s protective coloring (pigment).

Sunburn in a very light-skinned person may occur in less than 15 minutes of midday sun exposure, while a dark-skinned person may tolerate the same exposure for hours.

Keep in mind:

There is no such thing as a “healthy tan.” Unprotected sun exposure causes early aging of the skin.
Sun exposure can cause first and second degree burns.
Skin cancer usually appears in adulthood. But it is caused by sun exposure and sunburns that began as early as childhood. You can help prevent skin cancer by protecting your skin and your children’s skin from the harmful rays of the sun.

Factors that make sunburn more likely:

Infants and children are very sensitive to the burning effects of the sun.
People with fair skin are more likely to get sunburn. But even dark and black skin can burn and should be protected.
The sun’s rays are strongest during the hours of 10 a.m. to 4 p.m. The sun’s rays are also stronger at higher altitudes and lower latitudes (closer to the tropics). Reflection off water, sand, or snow can make the sun’s burning rays stronger.
Sun lamps can cause severe sunburn.
Some medications (such as the antibiotic doxycycline) can make your skin easier to sunburn.
Some medical conditions (such as lupus) can make you more sensitive to the sun.

Prevention

Sunburn is better prevented than treated. Ways to prevent sunburn include:

Use a broad spectrum sunscreen of SPF 30 or higher. A broad spectrum sunscreen protects from both UVB and UVA rays.
Apply a generous amount of sunscreen to fully cover exposed skin. Reapply sunscreen every 2 hours or as often as the label says.
Apply sunscreen after swimming or sweating and even when it is cloudy.
Use a lip balm with sunscreen.
Wear a hat and other protective clothing. Light-colored clothing reflects the sun most effectively.
Stay out of the sun during hours when the sun’s rays are strongest between 10 a.m. and 4 p.m.
Wear sunglasses with UV protection.

At Home Care

Take a cool shower or bath or place clean wet, cool wash rags on the burn.
Do not use products that contain benzocaine or lidocaine. These can cause allergy in some persons and make the burn worse.
If there are blisters, dry bandages may help prevent infection.
If your skin is not blistering, moisturizing cream may be applied to relieve discomfort. Do not use butter, petroleum jelly (Vaseline), or other oil-based products. These can block pores and so that heat and sweat cannot escape, which can lead to infection.
Over-the-counter medicines, such as ibuprofen or acetaminophen, help to relieve pain from sunburn. Do not give aspirin to children.
Cortisone creams may help reduce the inflammation.
Loose cotton clothing should be worn.

When to Contact A Medical Professional

Call a health care provider right away if you have a fever with sunburn. Also call if there are signs of shock, heat exhaustion, dehydration, or other serious reactions. These signs include:

Feeling faint or dizzy
Rapid pulse or rapid breathing
Extreme thirst, no urine output, or sunken eyes
Pale, clammy, or cool skin
Nausea, fever, chills, or rash
Your eyes hurt and are sensitive to light
Severe, painful blisters

What To Expect at Your Office Visit

The doctor will perform a physical exam and look at your skin. You may be asked questions about your medical history and current symptoms, including:

When did the sunburn occur?
How often do you get sunburn?
Do you have blisters?
How much of the body was sunburned?
What medicines do you take?
Do you use a sunblock or sunscreen? What type? How strong?
What other symptoms do you have?

References

Krakowski AC, Kaplan LA. Exposure to radiation from the sun. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, Pa: 2011:chap. 14.

Lim HW, Hawk JLM. Photodermatologic disorders. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 87.