Sunburn

Definition

Sunburn — red, painful skin that feels hot to the touch — usually appears within a few hours after sun exposure and may take several days or longer to fade.

Intense sun exposure that results in sunburn increases your risk of certain complications and related skin diseases. These include dry, wrinkled skin, liver spots, actinic keratoses, and skin cancer, including melanoma.

You can prevent sunburn and the related skin conditions by protecting your skin whenever you're outdoors, even on cloudy days. If you do get sunburn, several home remedies and treatments can relieve your pain and speed the healing of your skin.

Symptoms

Signs and symptoms of sunburn include:

• Pinkness or redness
• Skin that feels warm or hot to the touch
• Pain or tenderness
• Swelling
• Small fluid-filled blisters, which may break
• Headache, fever and fatigue if sunburn covers a large area

Any part of your body, including your earlobes, scalp and lips, can burn. Your eyes, which are extremely sensitive to the sun's ultraviolet light, also can burn. Sunburned eyes may feel painful or gritty.

Signs and symptoms of sunburn usually appear within a few hours after sun exposure. But it may take a day or longer to know the full extent and severity of sunburn.

Within a few days, your body starts to heal itself by "peeling" the top layer of damaged skin. After peeling, your skin may temporarily have an irregular color and pattern. Depending on the severity, it may take several days or longer for the sunburn to heal.

When to see a doctor
See your doctor if the sunburn:

• Is blistering and covers a large portion of your body
• Is accompanied by a high fever, extreme pain, headache, confusion, nausea or chills
• Doesn't respond to at-home care within a few days

Also, seek medical care if you notice signs or symptoms of an infection. These include:

• Increasing pain and tenderness
• Increasing swelling
• Yellow drainage (pus) from an open blister
• Red streaks, leading away from the open blister, which may extend in a line upward along your arm or leg

Causes

Sunburns are caused by exposure to too much ultraviolet (UV) light. UV radiation is a wavelength of sunlight in a range too short for the human eye to see. UV light is divided into three wavelength bands — ultraviolet A (UVA), ultraviolet B (UVB) and ultraviolet C (UVC). Only UVA and UVB rays reach the earth. Commercial tanning lamps and tanning beds also produce UV light and can cause sunburn.

When you're exposed to UV light, your skin accelerates its production of melanin. Melanin is the dark pigment in the epidermis that gives your skin its normal color. The extra melanin — produced to protect the skin's deeper layers — creates the darker color of a "tan." A suntan is actually your body's way of blocking the UV rays to prevent sunburn and other skin damage. But the protection only goes so far. The amount of melanin a person produces is determined genetically, and many people simply can't produce enough melanin to protect the skin well. Eventually, UV light causes the skin to burn, bringing pain, redness and swelling.

You can get sunburn on hazy or cloudy days. As much as 90 percent of UV rays pass through clouds. UV rays can also reflect off snow, ice, sand, water and other reflective surfaces, burning your skin as severely as direct sunlight.

Skin layers and melanin

Skin layers and melanin

Melanin is a natural pigment that gives your skin its color. It's produced in cells called melanocytes. ...

Risk factors

People with fair skin are more likely to sunburn than are people with dark skin. That's because people with darker skin have more melanin, which offers some protection from sunburn but not from UV-induced skin damage.

Skin color is determined by the number, distribution and type of pigment-producing cells (melanocytes) in the skin. Dermatologists refer to the degrees of pigmentation in skin as skin types. Skin types range from very little pigment (type I) to very darkly pigmented (type VI). How easily you burn depends on your skin type and how light or dark your skin is.

Regardless of your skin type, the sun's energy penetrates deeply into the skin and damages DNA of skin cells. This damage may ultimately lead to skin cancer, including melanoma. Even people with type V or VI skin can develop skin cancer, often on the palms, fingers or other more lightly pigmented areas of their bodies.

In addition to skin type, living in a sunny or high-altitude climate increases your risk of sunburn. People who live in sunny, warm climates are exposed to more sunlight than are people who live in colder climates. In addition, living at higher elevations, where the sunlight is strongest, exposes you to more radiation and increases your chances of sunburn and skin damage.

Complications

Intense sun exposure that results in sunburn increases your risk of certain complications and related skin diseases. These include infection, premature aging of your skin and skin cancer.

Infection
Ruptured blisters make you more susceptible to bacterial infection. See your doctor if you notice signs or symptoms of infection, which include pain, redness, swelling or oozing.

Photoaging
Sun exposure and repeated sunburns accelerate the aging process of skin, making you appear older than you are. Skin changes caused by the sun are called photoaging. The results of photoaging include:

• Weakening of connective tissues, which reduces the skin's strength and elasticity
• Thinner, more translucent-looking skin
• Deep wrinkles
• Dry, rough skin
• Fine red veins on your cheeks, nose and ears
• Freckles, mostly on your face and shoulders
• Large brown lesions (macules) on your face, back of hands, arms, chest and upper back (solar lentigines, or liver spots)
• White macules on the lower legs and arms

Actinic keratoses
Also known as solar keratoses, actinic keratoses appear as rough, scaly patches in sun-exposed areas. They vary in color from whitish, pink or flesh-colored to brown or dark brown patches. They're most commonly found on the face, ears, lower arms and backs of the hands of fair-skinned people whose skin has been damaged by the sun. Actinic keratoses are considered precancerous, because many evolve into skin cancer.

Skin cancer
Sun exposure that's intense enough to cause sunburn can also damage the DNA of skin cells. This damage sometimes leads to skin cancer. Skin cancer develops mainly on areas of skin exposed most to sunlight, including your scalp, face, lips, ears, neck, chest, arms and hands, and on the legs, especially in women.

Some types of skin cancer appear as a small growth or as a sore that bleeds easily, crusts over, heals and then reopens. In the case of melanoma, an existing mole may change or a new, suspicious-looking mole may develop. Other types of melanoma develop in areas of long-term sun exposure and start as dark flat spots that slowly darken and enlarge, known as lentigo maligna.

See your doctor if you notice a new skin growth, a bothersome change in your skin, a change in the appearance or texture of a mole, or a sore that doesn't heal.

Eye damage
The sun can also burn your eyes. UV light damages the retina, a thin layer of tissue that lines the back inner wall of your eye. Burning your eyes can also damage the lens, a clear structure inside your eye that changes shape to help focus objects. This can lead to progressive clouding of the lens (cataracts).

Preparing for your appointment

You're likely to first see your family doctor or primary care doctor. Before you go to your appointment, make a list of all medications that you're taking — including vitamins, herbs and over-the-counter drugs — as some medications increase your sensitivity to UV radiation.

For sunburn, some basic questions to ask your doctor include:

• Do I need prescription medication, or can I use over-the-counter medications to treat the condition?
• How soon after I begin treatment can I expect improvement?
• What skin care routines do you recommend while the sunburn heals?
• What suspicious changes in my skin should I look for?

If your doctor notices any skin abnormalities, such as lesions or suspicious moles, you may be referred to a doctor who specializes in skin diseases (dermatologist) for further evaluation.

What you can do in the meantime
While waiting for your appointment, these home remedies may reduce your pain and discomfort:

• Take an anti-inflammatory medication, such as ibuprofen (Advil, Motrin, others).
• Apply cold compresses to the affected skin, or take a cool bath or shower.
• Apply an aloe vera or after-sun lotion to your skin to decrease pain and swelling.

Tests and diagnosis

Your doctor is likely to conduct a physical exam and to ask questions about your symptoms, UV exposure and sunburn history.

If you experience sunburns or skin reactions after relatively minor exposures to sunlight, your doctor may recommend phototesting. During phototesting, small areas of your skin are exposed to measured amounts of UVA and UVB light to try to reproduce the problem. If your skin reacts to the UV radiation, you're considered sensitive to sunlight (photosensitive).

Treatments and drugs

Sunburn treatment doesn't heal your skin or prevent damage to your skin, but it can reduce pain, swelling and discomfort. If at-home care doesn't help or your sunburn is very severe, your doctor can prescribe medication. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Both topical and oral NSAIDs relieve pain, swelling and inflammation and are especially beneficial when given during the first 24 hours of sun exposure. Prescription NSAIDs provide higher potencies than do over-the-counter drugs. In one study, people who were treated with the topical NSAID diclofenac (Voltaren, Solaraze) within hours of sun exposure showed a significant decrease in pain and swelling 48 hours after applying the medication. Keep in mind that oral NSAIDs may also irritate your stomach and intestine.
• Corticosteroid medication. Topical corticosteroids may help relieve itching that occurs as your skin heals. Combining topical corticosteroids with either topical or oral NSAIDs may be more effective than using either one alone. Limited evidence supports the benefit of using oral steroids, such as prednisone, for sunburn. Using topical corticosteroids may cause thin skin, red lesions and acne.

Lifestyle and home remedies

Once sunburn occurs, you can't do much to limit damage to your skin. However, the following tips may reduce your pain and discomfort in the hours and days after sunburn:

• Take anti-inflammatory medication, such as aspirin or ibuprofen (Advil, Motrin, others), on a regular basis according to the label instructions until redness and soreness subside. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin intake has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns.
• Apply cold compresses — such as a towel dampened with cool tap water — to the affected skin. Or take a cool bath or shower.
• Apply a moisturizing cream, aloe vera lotion or hydrocortisone cream to affected skin. A low-dose (0.5 to 1 percent) hydrocortisone cream may decrease pain and swelling, and speed up healing.
• If blisters form, don't break them. They contain your natural body fluid (serum) and are a protective layer. Also, breaking blisters slows the healing process and increases the risk of infection. If needed, lightly cover blisters with gauze. If blisters break on their own, apply an antibacterial cream.
• Drink plenty of fluids. Sun exposure and heat can cause fluid loss through your skin. Be sure to replenish those fluids to prevent dehydration — when your body doesn't have enough water and other fluids to carry out its normal functions.
• Treat peeling skin gently. Within a few days, the affected area may begin to peel. This is simply your body's way of getting rid of the top layer of damaged skin. While your skin is peeling, continue to use moisturizing cream.

Some products — such as topical "-caine" products, for example, benzocaine — claim to relieve sunburn pain. Some dermatologists warn against using these products because they can irritate the skin or cause an allergic reaction. Benzocaine has also been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor.

Prevention

Use these methods to prevent sunburn:

• Avoid sun exposure between 10 a.m. and 4 p.m. Because the sun's rays are strongest during these hours, try to schedule outdoor activities for other times of the day. Seek shade whenever possible. If you're unable to avoid being in the sun, limit the amount of time you're outdoors during these peak hours.
• Cover up. Wear tightly woven clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than does a baseball cap or golf visor. Also consider wearing clothing or outdoor gear specially designed to provide sun protection.
• Use sunscreen frequently and liberally. Use a broad-spectrum sunscreen with an SPF of 15 or greater. The American Academy of Dermatology currently recommends using a broad-spectrum sunscreen with an SPF of 30 or more. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring. Even the best sunscreen might be less effective than the SPF number on the bottle would lead you to believe if it isn't applied thoroughly or thickly enough, or if it's perspired away or washed off while swimming. Use it even on cloudy or hazy days. UV rays can penetrate cloud cover.
• Wear sunglasses when outdoors. Look for a manufacturer's label that says the sunglasses block 99 or 100 percent of all UV light. To be even more effective, choose sunglasses that fit close to your face or have wraparound frames that block sunlight from all angles.

Some people try getting a "base" tan to prevent sunburn. The idea is that a few sessions of indoor tanning will protect them from burning in the sun. There's no scientific proof that this is true. A base tan is no substitute for sound sun protection. Plus, the risks of long-term tanning outweigh the unproven benefits of a base tan.