Sunburn

Symptoms

DEFINITION

• Red, painful skin following sun exposure

General Information

• Sunburn may cause a first-degree (redness and pain) or a second-degree (blistering) burn to the sun-exposed areas of the body.
• Long-term sun exposure increases the risk for skin cancer and causes aging of the skin.

Degrees of Sunburn

• First Degree: Most sunburn is a first-degree burn which turns the skin pink or red. The pain and swelling starts at 4 hours, peaks at 24 hours, and improves after 48 hours. 
• Second Degree: Prolonged sun exposure can cause blistering and a second-degree burn
• Third Degree: Sunburn never causes a third-degree burn or scarring.

Causes of Sunburn

• Broken mercury-vapor lamps (overhead lighting): Damaged mercury-vapor (metal halide) lamps are known to cause outbreaks of UV-radiation "sunburns" and photokeratitis (corneal irritation).
• Tanning lamps
• The Sun

Photokeratitis (Sunburn of Cornea)

• Definition: Photokeratitis can be thought of as a sunburn of the cornea. Exposure to intense light can cause corneal irritation (keratitis), especially if a person uses inadequate eye protection.
• Pain: Usually bilateral eye pain; tearing; light bothers eyes.
• Vision Loss: Usually minimal vision change (haziness) to none. More severe photokeratitis can cause blurred vision; all patients with blurred vision require medical evaluation; in skiers this is referred to as "snow blindness".
• Causes: This is most commonly seen in individuals with inadequate eye protection while outside on a bright sunny day (e.g., water sports, snow skiing). It can also occur in individuals who do not use eye protection while using a tanning booth. This can also occur in welders.

See More Appropriate Topic (instead of this one) If

• Chemical or thermal burn, see BURNS

FIRST AID Advice for Heatstroke or Sunstroke:

• Call EMS 911 immediately
• Move to a cool shady area. If possible, move into an air-conditioned place.
• Remove excess clothing or equipment (e.g., sports gear, protective work uniforms).
• Sponge the entire body surface with cool water (as cool as tolerated without shivering). If available, place ice packs on the neck, armpits and groin. Fan the patient to increase evaporation.
• Keep the feet elevated to counteract shock.
• If the patient is awake, give as much cold water or sports drink (e.g., Gatorade, Powerade) as he or she can tolerate.
• Fever medicines are of no value for heat stroke.

FIRST AID for Heat Exhaustion:

• Put the patient in a cool place. Lie down with the feet elevated.
• Undress patient (except for underwear) so the body surface can give off heat.
• Sponge the entire body surface continuously with cool water (as cool as tolerated without shivering). Fan the patient to increase evaporation.
• After 2 or 3 glasses of water, drive the patient in to be seen. During the drive, provide unlimited amounts of water.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE

Mild Sunburn

1. Ibuprofen for Pain: For pain relief, begin taking ibuprofen (e.g., Advil, Motrin) as soon as possible. Adult dosage is 400 mg every 6 hours. If anti-inflammatory agents such as ibuprofen are begun within 6 hours of sun exposure and continued for 2 days, they can greatly reduce your discomfort. If you can't take ibuprofen, use acetaminophen (e.g., Tylenol) instead.
   • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
2. Hydrocortisone Cream: Apply 1% hydrocortisone cream as soon as possible and then three times a day for 2 days. If begun early, it may reduce swelling and pain. If you don't have any hydrocortisone cream, use a moisturizing cream until you can get some.
   • Keep the cream in the refrigerator (Reason: it feels better if applied cold).
   • Available over-the-counter in U.S. as 0.5% and 1% cream.
   • Available over-the-counter in Canada as 0.5% cream.
3. Cool Baths: Apply cool compresses to the burned area several times a day to reduce pain and burning. For larger sunburns, give cool baths for 10 minutes (caution: avoid any chill). Add 2 oz. baking soda per tub. Avoid soap on the sunburn.
4. Extra Fluids: Drink extra water on the first day to replace the fluids lost into the sunburn and to prevent dehydration and dizziness.
5. Broken Blisters:
   • For broken blisters, trim off the dead skin with a fine scissors (Reason: these hidden pockets can become a breeding ground for infection).
   • Apply antibiotic ointment (e.g., Bacitracin) to the raw skin under broken blisters. Reapply twice daily for 3 days.
   • Caution: leave intact blisters alone (Reason: the intact blister protects the skin and allows it to heal).
6. Expected Course: Pain usually stops after 2 or 3 days. Skin flaking and peeling usually occur 5-7 days after the sunburn.
7. Call Your Doctor If:
   • Pain becomes severe and not improved after taking pain medication
   • Pain does not improve after 3 days
   • Sunburn looks infected
   • You become worse

Mild Photokeratitis

1. Photokeratitis (sunburn of cornea):
   • Definition: Photokeratitis can be thought of as a sunburn of the cornea. Exposure to intense light can cause corneal irritation (keratitis), especially if a person uses inadequate eye protection.
   • Causes: This is most commonly seen in individuals with inadequate eye protection while outside on a bright sunny day (e.g., water sports, snow skiing). It can also occur in individuals who do not use eye protection while using a tanning booth. This can also occur in welders.
2. Eye Treatment:
   • Apply cool wet compresses to the eyes.
   • Try to rest with your eyes closed.
   • Do not wear contacts until your eyes are completely better.
   • Avoid rubbing your eyes.
3. Expected Course:
   • Symptoms should disappear completely over the next 24 hours. There should be no permanent damage to the cornea.
   • You can prevent future eye symptoms from sun exposure by wearing sunglasses.
4. Call Your Doctor If:
   • Severe pain occurs
   • Pain lasts more than 24 hours
   • Pus or yellow/green discharge occurs
   • Blurred vision occurs
   • You become worse.

How to Prevent Sunburn

1. Prevention - Reduce Sun Exposure:
   • Try to avoid all sun exposure between 10 am and 3 pm.
   • You can get a sunburn while swimming. Water only blocks the ultraviolet radiation a little. 
2. Prevention - Clothing:
   • Wear a wide-brim hat; it protects your face and neck from the sun.
   • Wear shirts with long sleeves when outdoors and pants that go down to at least your knees.
3. Prevention - Use Sunscreen:
   • Apply sunscreen to areas that can't be protected by clothing. Generally, an adult needs about 1 oz of sunscreen lotion to cover the entire body.
   • You should reapply the sunscreen every 2-4 hours. You should also reapply after swimming, exercising, or sweating.
   • A sunscreen with a rating of SPF 15 to 30 should be used. Sunscreens with ratings higher than 30 provide minimal additional protection.
   • Sunscreens help prevent sunburn, but do not completely prevent skin damage. Thus, sun exposure can still increase your risk of skin aging and skin cancer.
4. Vitamins C and E: Vitamins C and E have anti-oxidant properties, which means they help prevent sun damage to cells in your skin. Taking vitamins C and E by mouth may partially reduce the sunburn reaction.
   • The adult dosage of vitamin C (ascorbic acid): 2 grams by mouth once a day.
   • Adult dosage of vitamin E (d-alpha-tocopherol): 1000 IU by mouth once a day.
   • Caution: Prevention is the key. Remember to reduce sun exposure and use sunscreens.
   • Read the package instructions thoroughly on all medications that you take.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

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