- Antony R Young, PhD
Antony R Young, PhD
- Professor, St John's Institute of Dermatology
- King's College School of Medicine
- Angela Tewari, MBBS, BSc, MRCP, PhD
Angela Tewari, MBBS, BSc, MRCP, PhD
- King’s College, London
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
Sunburn is an acute, delayed, and transient inflammatory response of the skin to excessive exposure to ultraviolet radiation (UVR) from natural sunlight or artificial sources (eg, tanning beds, phototherapy devices) (picture 1A-B). Both UVB (280 to 320 nm) and UVA (320 to 400 nm) can cause sunburn, but the wavelengths that are the most effective at inducing erythema are in the UVB range [1,2].
Sunburn is a self-limited condition. The acute manifestations usually resolve in three to seven days. However, susceptibility to sunburn is a marker of genetic susceptibility to skin cancer and is associated with an increased risk of melanoma at all ages [3,4]. It is very important that clinicians counsel patients with increased susceptibility to sunburn about sun protection.
This topic will discuss the pathogenesis, clinical manifestations, and management of sunburn. Photosensitivity, photoprotection, and photosensitivity disorders are discussed separately. (See "Overview of cutaneous photosensitivity: Photobiology, patient evaluation, and photoprotection" and "Selection of sunscreen and sun-protective measures" and "Photosensitivity disorders (photodermatoses): Clinical manifestations, diagnosis, and treatment".)
Sunburn is common. In the United States, the estimated sunburn prevalence among all adults was approximately 34 percent in 2004 . Prevalences ranging from 20 to 70 percent have been reported in cross-sectional studies in Europe and Australia [6-9].
Sunburn occurs more frequently among adolescents and young adults. In nation-wide surveys in the United States, approximately 70 percent of adolescents aged 11 to 18 years and 50 percent of adults aged 18 to 29 years reported at least one sunburn in the previous year [10,11].
- Young AR. Acute effects of UVR on human eyes and skin. Prog Biophys Mol Biol 2006; 92:80.
- Young AR, Chadwick CA, Harrison GI, et al. The similarity of action spectra for thymine dimers in human epidermis and erythema suggests that DNA is the chromophore for erythema. J Invest Dermatol 1998; 111:982.
- Chang YM, Barrett JH, Bishop DT, et al. Sun exposure and melanoma risk at different latitudes: a pooled analysis of 5700 cases and 7216 controls. Int J Epidemiol 2009; 38:814.
- Dennis LK, Vanbeek MJ, Beane Freeman LE, et al. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol 2008; 18:614.
- Centers for Disease Control and Prevention (CDC). Sunburn prevalence among adults--United States, 1999, 2003, and 2004. MMWR Morb Mortal Wkly Rep 2007; 56:524.
- Horsley L, Charlton A, Waterman C. Current action for skin cancer risk reduction in English schools: pupils' behaviour in relation to sunburn. Health Educ Res 2002; 17:715.
- Køster B, Thorgaard C, Philip A, Clemmensen IH. Prevalence of sunburn and sun-related behaviour in the Danish population: a cross-sectional study. Scand J Public Health 2010; 38:548.
- Bränström R, Kristjansson S, Dal H, Rodvall Y. Sun exposure and sunburn among Swedish toddlers. Eur J Cancer 2006; 42:1441.
- Rogers C, Kvaskoff M, DiSipio T, et al. Prevalence and determinants of sunburn in Queensland. Health Promot J Austr 2009; 20:102.
- Centers for Disease Control and Prevention (CDC). Sunburn and sun protective behaviors among adults aged 18-29 years--United States, 2000-2010. MMWR Morb Mortal Wkly Rep 2012; 61:317.
- Cokkinides V, Weinstock M, Glanz K, et al. Trends in sunburns, sun protection practices, and attitudes toward sun exposure protection and tanning among US adolescents, 1998-2004. Pediatrics 2006; 118:853.
- Diffey BL. What is light? Photodermatol Photoimmunol Photomed 2002; 18:68.
- Diffey BL. Sources and measurement of ultraviolet radiation. Methods 2002; 28:4.
- Moehrle M, Koehle W, Dietz K, Lischka G. Reduction of minimal erythema dose by sweating. Photodermatol Photoimmunol Photomed 2000; 16:260.
- Mukamal KJ. Alcohol consumption and self-reported sunburn: a cross-sectional, population-based survey. J Am Acad Dermatol 2006; 55:584.
- Duffy SA, Choi SH, Hollern R, Ronis DL. Factors associated with risky sun exposure behaviors among operating engineers. Am J Ind Med 2012; 55:786.
- Warthan MM, Sewell DS, Marlow RA, et al. The economic impact of acute sunburn. Arch Dermatol 2003; 139:1003.
- Kochevar IE, Taylor CR, Krutmann J. Fundamentals of Cutaneous Photobiology and Photoimmunology. In: Fitzpatrick's Dermatology in General Medicine, 8th Edition, Goldsmith LA, Katz SI, Gilchrest BA, et al. (Eds), The Mc Graw-Hill Companies, Inc., 2012. Vol 1.
- Olsen CM, Zens MS, Green AC, et al. Biologic markers of sun exposure and melanoma risk in women: pooled case-control analysis. Int J Cancer 2011; 129:713.
- van Dam RM, Huang Z, Rimm EB, et al. Risk factors for basal cell carcinoma of the skin in men: results from the health professionals follow-up study. Am J Epidemiol 1999; 150:459.
- Harrison GI, Young AR. Ultraviolet radiation-induced erythema in human skin. Methods 2002; 28:14.
- Young AR, Orchard GE, Harrison GI, Klock JL. The detrimental effects of daily sub-erythemal exposure on human skin in vivo can be prevented by a daily-care broad-spectrum sunscreen. J Invest Dermatol 2007; 127:975.
- Rhodes LE, Lim HW. The acute effects of ultraviolet radiation on the skin. In: Photodermatology, Lim HW, Honigsmann H, Hawk JLM. (Eds), Informa Healthcare USA Inc., New York 2007. p.75.
- Nicolaou A, Pilkington SM, Rhodes LE. Ultraviolet-radiation induced skin inflammation: dissecting the role of bioactive lipids. Chem Phys Lipids 2011; 164:535.
- Rhodes LE, Gledhill K, Masoodi M, et al. The sunburn response in human skin is characterized by sequential eicosanoid profiles that may mediate its early and late phases. FASEB J 2009; 23:3947.
- Rhodes LE, Belgi G, Parslew R, et al. Ultraviolet-B-induced erythema is mediated by nitric oxide and prostaglandin E2 in combination. J Invest Dermatol 2001; 117:880.
- Nicolaou A, Masoodi M, Gledhill K, et al. The eicosanoid response to high dose UVR exposure of individuals prone and resistant to sunburn. Photochem Photobiol Sci 2012; 11:371.
- Murphy G, Young AR, Wulf HC, et al. The molecular determinants of sunburn cell formation. Exp Dermatol 2001; 10:155.
- Young AR, Guy RH, Maibach HI. Laser Doppler velocimetry to quantify UV-B induced increase in human skin blood flow. Photochem Photobiol 1985; 42:385.
- Gilchrest BA, Soter NA, Stoff JS, Mihm MC Jr. The human sunburn reaction: histologic and biochemical studies. J Am Acad Dermatol 1981; 5:411.
- Hawk JL, Murphy GM, Holden CA. The presence of neutrophils in human cutaneous ultraviolet-B inflammation. Br J Dermatol 1988; 118:27.
- Terui T, Takahashi K, Funayama M, et al. Occurrence of neutrophils and activated Th1 cells in UVB-induced erythema. Acta Derm Venereol 2001; 81:8.
- Terui T, Tagami H. Mediators of inflammation involved in UVB erythema. J Dermatol Sci 2000; 23 Suppl 1:S1.
- Rhodes LE. The acute effects of ultraviolet radiation on the skin. In: Photodermatology, Lim HW, Honigsmann H, Hawk JL. (Eds), Informa Healthcare, New York 2007. p.75.
- Harrison GI, Young AR, McMahon SB. Ultraviolet radiation-induced inflammation as a model for cutaneous hyperalgesia. J Invest Dermatol 2004; 122:183.
- Lehmann AR, McGibbon D, Stefanini M. Xeroderma pigmentosum. Orphanet J Rare Dis 2011; 6:70.
- DiGiovanna JJ, Kraemer KH. Shining a light on xeroderma pigmentosum. J Invest Dermatol 2012; 132:785.
- Pao C, Norris PG, Corbett M, Hawk JL. Polymorphic light eruption: prevalence in Australia and England. Br J Dermatol 1994; 130:62.
- Edwards EK Jr, Horwitz SN, Frost P. Reduction of the erythema response to ultraviolet light by nonsteroidal antiinflammatory agents. Arch Dermatol Res 1982; 272:263.
- Gruber CM Jr, Ridolfo AS, Nickander R, Mikulaschek WM. Delay of erythema of human skin by anti-inflammatory drugs after ultraviolet irradiation. Clin Pharmacol Ther 1972; 13:109.
- Miller WS, Ruderman FR, Smith JG Jr. Aspirin and ultraviolet light-induced erythema in man. Arch Dermatol 1967; 95:357.
- Stern RS, Dodson TB. Ibuprofen in the treatment of UV-B-induced inflammation. Arch Dermatol 1985; 121:508.
- Russo PM, Schneiderman LJ. Effect of topical corticosteroids on symptoms of clinical sunburn. J Fam Pract 1978; 7:1129.
- Faurschou A, Wulf HC. Topical corticosteroids in the treatment of acute sunburn: a randomized, double-blind clinical trial. Arch Dermatol 2008; 144:620.
- Kienzler JL, Magnette J, Queille-Roussel C, et al. Diclofenac-Na gel is effective in reducing the pain and inflammation associated with exposure to ultraviolet light - results of two clinical studies. Skin Pharmacol Physiol 2005; 18:144.
- Fernández-Jorge B, Goday-Buján JJ, Murga M, et al. Photoallergic contact dermatitis due to diclofenac with cross-reaction to aceclofenac: two case reports. Contact Dermatitis 2009; 61:236.
- Kowalzick L, Ziegler H. Photoallergic contact dermatitis from topical diclofenac in Solaraze gel. Contact Dermatitis 2006; 54:348.
- Lynde CB, Pierscianowski TA, Pratt MD. Allergic contact dermatitis caused by diclofenac cream. CMAJ 2009; 181:925.
- Greenwald JS, Parrish JA, Jaenicke KF, Anderson RR. Failure of systemically administered corticosteroids to suppress UVB-induced delayed erythema. J Am Acad Dermatol 1981; 5:197.
- Miyamura Y, Coelho SG, Schlenz K, et al. The deceptive nature of UVA tanning versus the modest protective effects of UVB tanning on human skin. Pigment Cell Melanoma Res 2011; 24:136.
- Individual susceptibility
- Action spectra
- Mechanism of UVB-induced inflammation
- CLINICAL MANIFESTATIONS
- Clinical course
- DIFFERENTIAL DIAGNOSIS
- Exaggerated sunburn reactions
- Nonsunburn reactions
- Mild to moderate sunburn
- Patients with severe sunburn
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS