Patient information: Sunburn

SUNBURN OVERVIEW

Sunburn occurs when skin is burned by ultraviolet (UV) radiation, 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 increase your risk of developing skin cancer, wrinkles, and other cosmetic concerns.

This article the symptoms, causes, potential complications, and treatment of sunburn. Prevention of sunburn is discussed separately. (See "Patient information: Sunburn prevention".) Severe sunburns are treated like other skin burns, and are discussed separately. (See "Patient information: Skin burns".) More detailed information about sunburn is available by subscription. (See "Sunburn".)

SUNBURN SYMPTOMS

Unlike other types of skin burns, sunburn is not immediately apparent because redness develops between three and five hours after being out in the sun. Common symptoms of sunburn include reddened skin that is hot to the touch and skin pain; more severe sunburns cause skin swelling and blistering (picture 1 and picture 2). (See "Patient information: Skin burns".)

Redness peaks approximately 12 to 24 hours after sun exposure and 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 UV radiation from the sun or a tanning bed, it becomes burned.

The amount of UV radiation 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 higher risk of sunburn compared to 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 higher risk for developing sunburn.
• Certain medications make the skin more sensitive to burning. This includes nonsteroidal antiinflammatory drugs (eg, ibuprofen), quinolone and tetracycline antibiotics (eg, Cipro®, tetracycline), furosemide (Lasix®) and hydrochlorothiazide (HCTZ), psoralens (methoxsalen/Oxsoralen®) and phenothiazines (eg, compazine). If you take one or more of these medications, you should avoid the sun and use protective measures (eg, sunscreen) to avoid sunburn.

SUNBURN COMPLICATIONS

Sunburn is associated with premature aging and wrinkling of the skin as well as skin cancer, including malignant melanoma, a serious form of skin cancer. Sun exposure and ultraviolet damage can also increase the risk of developing cataracts (when the lens in the eye becomes cloudy). (See "Patient information: Basal cell and squamous cell skin cancer" and "Patient information: Melanoma treatment; localized melanoma".)

SUNBURN TREATMENT

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 a non-steroidal antiinflammatory 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. Recommended doses of these medications are listed in table 1 .

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®, Dermaplast®). 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).

PREVENTING SUNBURN

The prevention of sunburn is discussed in a separate article. (See "Patient information: Sunburn prevention".)

WHEN TO SEEK HELP

If you have a severe sunburn, call your healthcare 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 a severe sunburn include severe skin pain and skin blistering (picture 2). People with severe sunburn can also have heat stroke or heat exhaustion, which can cause fever, headache, confusion, nausea, vomiting, blurry vision, and fainting. If you have any of these problems, you should go to the emergency department immediately.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:
Patient information: Melanoma treatment; localized melanoma
Patient information: Sunburn prevention
Patient information: Skin burns
Patient information: Basal cell and squamous cell skin cancer

Professional Level Information:
Actinic keratosis
Epidemiology and clinical features of basal cell carcinoma
Epidemiology and clinical features of cutaneous squamous cell carcinoma
Primary prevention of melanoma
Risk factors for the development of melanoma
Screening and early detection of melanoma
Sunburn
Treatment and prognosis of basal cell carcinoma
Treatment and prognosis of cutaneous squamous cell carcinoma

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/sunexposure.html, available in Spanish)

• Center for Disease Control and Prevention

       (www.cdc.gov/cancer/skin/chooseyourcover/)

• The National Cancer Institute

       (www.nci.nih.gov/cancertopics/pdq/prevention/skin/Patient/page2)

• The Environmental Protection Agency

       (www.epa.gov/sunwise/)

• The Skin Cancer Foundation

       (www.skincancer.org/index.php)

• The National Council on Skin Cancer Prevention

       (www.skincancerprevention.org)

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