Patient education: Sunburn (Beyond the Basics)
- Antony R Young, PhD
Antony R Young, PhD
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine
- King's College London, London, United Kingdom
- Angela Tewari, MBBS, BSc, MRCP, PhD
Angela Tewari, MBBS, BSc, MRCP, PhD
- King’s College, London
- Section Editor
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
Sunburn occurs when skin is burned by ultraviolet radiation (UVR), most often after being in the sun for too long. It is common, with more than 30 percent of adults and 70 percent of children and adolescents reporting at least one sunburn during the course of a year. Although most sunburns are not severe, a lifetime of sun exposure and/or frequent sunburns significantly increases your risk of developing skin cancer, wrinkles, and other cosmetic concerns.
This article addresses the symptoms, causes, potential complications, and treatment of sunburn. Prevention of sunburn is discussed separately (see "Patient education: Sunburn prevention (Beyond the Basics)"). Severe sunburns are treated like other skin burns and are discussed separately (see "Patient education: Skin burns (Beyond the Basics)"). More detailed information about sunburn is available by subscription. (See "Sunburn".)
Unlike other types of skin burns, sunburn may not be immediately apparent because redness starts to develop between three and five hours after being out in the sun. Common symptoms of sunburn include reddened skin that is hot to the touch (picture 1), skin pain, and increased sensitivity to skin pressure and heat (eg, hot water); more severe sunburns cause skin swelling and blistering (see "Patient education: Skin burns (Beyond the Basics)"). The sunburn damage in the skin also triggers skin tanning. It is a well-known fact that tanning is the body's response to damage to the skin cells.
Redness peaks approximately 12 to 24 hours after sun exposure and typically fades over 72 hours.
SUNBURN CAUSES AND RISK FACTORS
Normally, the skin is protected from the sun by a substance in the skin called melanin. Melanin is a pigment (coloring) that causes your skin to appear light or dark colored. If your skin is exposed to excessive ultraviolet radiation (UVR) from the sun or a tanning bed, it becomes burned.
The amount of UVR required to burn your skin depends upon:
●The amount of melanin in your skin. In general, people with fair skin and light-colored hair have less melanin and are at a higher risk of sunburn compared with people with darker-colored skin. Some people can develop sunburn after less than 15 minutes of sun exposure.
●Where you are. People in regions that are closest to the equator and high altitudes (eg, mountainous areas) are at a higher risk for developing sunburn. Take extra precautions when you are exposed to a breeze (eg, sailing) because this masks the heat of the sun, which is a good guide to the intensity of UVR. Also remember that snow reflects UVR.
●Certain medications make the skin more sensitive to sunburn. This includes nonsteroidal anti-inflammatory drugs (eg, ibuprofen), quinolone and tetracycline antibiotics (eg, Ciprofloxacin, tetracycline), diuretics such as furosemide (Lasix) and hydrochlorothiazide (HCTZ), psoralens (methoxsalen/Oxsoralen), and phenothiazines (eg, Compazine). Other drugs include amiodarone and antifungals, including voriconazole, itraconazole, and fluconazole. If you take one or more of these medications, you should avoid the sun and use protective measures (eg, sunscreen) to avoid sunburn.
Sunburn is associated with premature skin aging (eg, wrinkling of the skin) as well as skin cancer, including malignant melanoma, a very serious form of skin cancer. Sun exposure and ultraviolet radiation damage can also increase the risk of developing cataracts (when the lens in the eye becomes cloudy). (See "Patient education: Melanoma treatment; localized melanoma (Beyond the Basics)".)
Treatments for sunburn can help to relieve skin discomfort. You should stay out of the sun until your skin redness and pain resolve. You can take nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen to relieve pain. These medications are especially helpful if you take them as soon as you notice pain; the benefit of NSAIDs decreases after 24 hours. However, it is important to bear in mind that you need to be careful about going in the sun afterwards.
For mild sunburns, there are a number of products advertised to relieve pain, including cool compresses, aloe-based lotions, and lotions or sprays with a local anesthetic (numbing medication, eg, Solarcaine, Dermoplast). Although studies have not proven that these products are helpful, they are not likely to be harmful. However, these products do not reduce the long-term risks of sunburn (eg, skin cancer).
The prevention of sunburn is discussed in a separate article. (See "Patient education: Sunburn prevention (Beyond the Basics)".)
WHEN TO SEEK HELP
If you have a severe sunburn, call your health care provider to determine if you can use treatment at home or if you need to be evaluated in the office or an emergency department.
Symptoms of severe sunburn include severe skin pain and skin blistering. People with severe sunburn can also have heat stroke or heat exhaustion (when your body temperature is extremely high), which can cause fever, headache, confusion, nausea, vomiting, blurred vision, and fainting. If you have any of these problems, you should go to the emergency department immediately.
WHERE TO GET MORE INFORMATION
Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website (www.uptodate.com/contents/table-of-contents/patient-education). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Clinical features and diagnosis of cutaneous squamous cell carcinoma (SCC)
Epidemiology, natural history, and diagnosis of actinic keratosis
Epidemiology, pathogenesis, and clinical features of basal cell carcinoma
Epidemiology and risk factors for cutaneous squamous cell carcinoma
Primary prevention of melanoma
Risk factors for the development of melanoma
Screening and early detection of melanoma in adults and adolescents
Selection of sunscreen and sun-protective measures
Treatment and prognosis of basal cell carcinoma at low risk of recurrence
Treatment and prognosis of cutaneous squamous cell carcinoma
Treatment of actinic keratosis
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/sunexposure.html, available in Spanish)
●Center for Disease Control and Prevention
●The National Cancer Institute
●The Environmental Protection Agency
●The Skin Cancer Foundation
●The National Council on Skin Cancer Prevention
- Diffey BL. When should sunscreen be reapplied? J Am Acad Dermatol 2001; 45:882.
- Geller AC, Colditz G, Oliveria S, et al. Use of sunscreen, sunburning rates, and tanning bed use among more than 10 000 US children and adolescents. Pediatrics 2002; 109:1009.
- 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.
- 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.
- Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. J Am Acad Dermatol 2017; 76:S100.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.