Sunburn in Adult
Alerts and Notices
SynopsisSunburn (solar erythema) is the skin's reaction to excessive ultraviolet (UV) light exposure. It presents as reddening and tenderness of the skin that typically appears 30 minutes to 8 hours after exposure and peaks between 12 and 24 hours after exposure. UVB radiation is much more potent than UVA at inducing erythema; the 300-nm wavelength within the UVB range is the most erythemogenic. Severe sunburn can evolve into edema, blistering, and desquamation, the latter of which occurs 4-7 days after the exposure as the erythema is fading. Extreme reactions may include systemic symptoms such as chills and malaise and may necessitate hospitalization and management similar to thermal burns. Sunburn incidence is increased in areas that are closer to the equator and higher in altitude. Sunburn occurs more frequently in lighter-skinned individuals and in younger age groups. Darker skin colors are more resistant to sunburn due to increased epidermal melanin content, type of melanin produced (ie, eumelanin versus pheomelanin), and different melanosome dispersion patterns. Skin phototypes (Fitzpatrick classification) are classified on the basis of susceptibility to sunburn and ability to tan:
I: Always burns, never tans
II: Frequently burns, rarely tans
III: Infrequently burns, usually tans
IV: Low susceptibility to sunburn, light brown skin color
V: Very low susceptibility to sunburn, brown skin color
VI: Extremely low susceptibility to sunburn, dark brown skin color
Although sunburn is self-limiting, there is morbidity and mortality associated with long-term sun exposure. UV radiation (UVR) causes direct DNA damage to the skin cells in addition to suppression of skin immunity. Repeated exposure can cause permanent DNA damage. Sunburn is a risk factor for the development of squamous cell carcinoma, basal cell carcinoma, and melanoma. Having as little as 5 sunburns over a decade or 1 sunburn every 10 years can result in up to triple the risk of melanoma. Both childhood and adult sunburns can contribute to melanoma risk.
L55.9 – Sunburn, unspecified
403194002 – Solar erythema
Differential Diagnosis & PitfallsMany drugs that are phototoxic and cause exaggerated sunburn are active in the UVA spectrum. UVA can pass through window glass that stops UVB (the usual wavelength for inducing skin cancer).
- Photosensitive drug eruption
- Photoallergic reaction
- Polymorphous light eruption
- Solar urticaria
- Chronic actinic dermatitis
- Exfoliative dermatitis
- Atopic dermatitis
- Chemical or thermal burns (see thermal or electrical burn; chemical burns are covered separately, by chemical agent)
- Lupus erythematosus
- Acute contact dermatitis
Patient Information for Sunburn in Adult
OverviewSunburn is caused by the skin's reaction to ultraviolet light exposure from the sun. It appears around 4 to 24 hours after the exposure. The affected skin is red and may be painful or blistered. When sunburn subsides, peeling of the skin may be seen.
Some medical conditions, such as lupus and porphyria, as well as some oral medications, most commonly hydrochlorothiazide (a blood pressure medication), may make the skin more sensitive to sunburn.
Getting a sunburn raises the lifetime risk of developing skin cancer. Sunburn and sun exposure also increase wrinkling and other signs of premature aging in the skin. Additionally, it is important to know that tanning beds are a source of the same light that causes sunburns, premature aging, and skin cancer.
Who’s At RiskSunburn occurs in people of all ages, particularly in individuals with lighter skin colors. People with darker skin colors have more pigment (melanin), which is protective, but sunburn and/or tanning of the skin can occur, except in the darkest skin colors, and no one is immune to developing skin cancer.
Signs & SymptomsSunburn may occur on any sun-exposed area. Sunburn appears as immediate redness as soon as 4 hours after exposure, followed by deep redness and blister formation in severe sunburn. Long-lasting redness may be present for weeks after the actual burn.
Self-Care GuidelinesIf you get a sunburn, further direct sun exposure should be avoided for a few days. Cool water or cool milk soaks may help cool and soothe the affected areas. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help decrease the redness and pain. Be sure to drink lots of fluids while recovering from your sunburn.
Note that applying a greasy cream or ointment may actually make the pain worse by trapping heat on the skin.
Do not attempt to break any blisters that form; you can cover them with gauze, if necessary. If any blisters break on their own, a topical antibiotic ointment (eg, Neosporin) can be applied. A moisturizer can help with skin peeling afterward. Avoid topical products that end in "caine," such as lidocaine, as they can sometimes further irritate the skin.
Prevention is very important. To reduce the risk of skin cancer later in life, it is important to prevent sunburns.
- Avoid direct sun in the middle of the day (10 AM to 3 PM). Be mindful that snow and water reflect light to the skin. Also note that clouds still let a lot of light through, so you can still be exposed to ultraviolet light, even on cloudy days.
- Wear a hat with a wide brim. Baseball hats do not provide as much protection.
- Cover up with tightly woven clothing. Some manufacturers make specialty clothing with an ultraviolet protection factor (UPF) rating.
- Use sunscreen on all exposed skin areas, including the lips, before going outdoors. A broad-spectrum sunscreen (meaning it blocks UVB and UVA light) with an SPF of at least 30 is best. Apply sunscreen generously 30 minutes before going outdoors, and reapply every 2 hours or after swimming or sweating a lot. Sunscreen sprays tend not to provide a thick enough layer on your skin. Therefore, sunscreen lotions or creams are recommended.
- Avoid using tanning beds.
- In front of a full-length mirror, inspect the front of your body, making sure to look at your neck, chest (including under breasts), legs, and genitals.
- With your arms raised, inspect both sides of your body, making sure to examine your underarms.
- With your elbows bent, examine the front and back of your arms as well as your elbows, hands, fingers, areas between your fingers, and fingernails.
- Inspect the tops and bottoms of your feet, the areas between your toes, and your toenails.
- With your back to the mirror and holding a hand mirror, inspect the back of your neck, shoulders, legs, and buttocks.
- Using a hand mirror, examine your scalp and face.
When to Seek Medical CareSunburn does not require a health professional's care. If you have a fever; however, see a health professional because that indicates possible heatstroke. Additionally, if you are burned over a large portion of your body and there is severe discomfort and inflammation, seek medical attention. Also seek medical advice if there are signs of infection (such as swelling, pus, or blisters that turn yellow or red).
TreatmentsFor severe burns, in addition to pain-relieving medicine (usually NSAIDs, such as ibuprofen [Motrin] and naproxen [Aleve]), your health professional may prescribe a topical steroid cream or lotion, or prednisone, an oral steroid, to help reduce the inflammation.
Sunburn in Adult