Sunburn (Sun Poisoning)

Facts on Sunburn

Sunburn results from too much sun or sun-equivalent exposure. Almost everyone has been sunburned or will become sunburned at some time. Anyone who visits a beach, goes fishing, works in the yard, or simply is out in the sun can get sunburned. Sunburn is possible any time of year, but is more common in the summer months when the sun's rays are the strongest. Improper tanning bed use is also a source of sunburn. Although seldom fatal, severe sunburn or sun poisoning can be disabling and cause quite a bit of discomfort.

A Skin Cancer Foundation survey found that one of three adults reported getting sunburned at least once in the past year. One or more blistering sunburns in childhood or adolescence more than double a person's chances of developing melanoma later in life, according to the Skin Cancer Foundation. A person's risk for melanoma doubles if he or she has had five or more sunburns at any age.

What Causes Sunburn?

  • Mild and uncomplicated cases of sunburn usually result in minor skin redness, and pain.
  • Initially, the skin turns red about 2 to 6 hours after exposure and feels irritated. The peak effects are noted at 12 to 24 hours.
  • More severe cases (sun poisoning) are complicated by severe skin burning and blistering, massive fluid loss (dehydration), electrolyte imbalance, and possibly infection.
  • With too much exposure, severe untreated sunburn can cause shock (poor circulation to vital organs) and even death.

What Are the Symptoms of Sunburn?

Other common symptoms include:

  • Chills
  • Fever
  • Nausea or vomiting
  • Flulike symptoms
  • Blistering that may range from a very fine blister that is only found when you begin to "peel" to very large water-filled blisters with red, tender, raw skin underneath. When blisters pop, the skin that covered the blisters will slough off.
  • Skin loss (peeling) about 4 to 7 days after exposure

Some individuals experience a sun rash (sometimes called sun poisoning) due to a condition called polymorphous light eruption (PMLE). About 10% of Americans are affected by PMLE, a reaction that does not appear to be linked to drugs or diseases.

Symptoms of PMLE are a mild to severe skin rash, usually appearing within 30 minutes to several hours of sun exposure. The rash may be itchy and have these characteristics:

  • Small bumps all over the body, predominantly in sun-exposed areas
  • Sun rash progresses to dense clumps of bumps
  • Hives, usually on the arms, lower legs, and chest

Sunburn Pictures

Picture of peeling skin from sunburn
Picture of peeling skin from sunburn

Picture of sunburn
Picture of sunburn

Protect yourself from the sun.

Summer Survival Kit

If your summer includes relaxing on the beach, lake, or river, a well–planned survival kit can ensure that you have a fun and healthy experience. Don't forget the following items when packing your weekend bag:

  1. Sunscreen with adequate protection against both UVA and UVB rays. While sunscreen should be applied at home about a half hour before sun exposure, you'll need to re–apply more when you arrive. Studies show that most people apply far too little sunscreen, and the SPF of any product is reduced when it's applied too thinly. You'll need to reapply sunscreen after swimming or if you perspire a great deal.
  1. A watch of some type to recognize how long you've been in the sun. You also need to know when it's time to avoid sun exposure ? from 10 am to 2 pm, when the sun's rays are most intense.

When to Seek Medical Care for Sunburn

If you feel a sunburn is severe, call the doctor. The doctor can then decide to treat the individual at home or in the office or refer them to an emergency department.

If a person suffers any of these conditions with sunburn they should go to a hospital's emergency department:

How Is a Sunburn Diagnosed?

The doctor will obtain a medical history and perform a physical examination to determine if the patient has a sunburn, and to what extent. In more severe cases, or for people with preexisting medical problems, the doctor may order laboratory tests to aid in determining the severity of the injury.

What Is the Treatment for Sunburn?

First aid treatment for sunburn includes over-the-counter pain relievers (for example, ibuprofen or naproxen, which are anti-inflammatory drugs), and sunburn gels or creams. If medical treatment is necessary, stronger pain medication, antibiotics, or silver sulfadiazine may be prescribed.

What Are Home Remedies for Sunburn?

Home care begins prior to a sunburn. Prevention is the most important step to avoid short-term consequences of sun exposure (redness, pain, blistering) and the long-term risks for skin damage and skin cancer.

Immediate self-care is aimed at stopping the UV radiation.

  • Get out of the sun
  • Cover exposed skin
  • Do not use tanning beds
  • Use SPF (sun protection factor) of 30 or higher and apply frequently when outdoors.

Relief of the discomfort becomes important, and there are several sunburn remedies.

  • Medications such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) to decrease pain and inflammation are useful, especially when started early.
  • For mild sunburn, cool compresses with equal parts of milk and water may suffice. Cold compresses with Burow's solution may also be used, and can be bought at a drugstore. Dissolve 1 packet in 1 pint of water. Soak gauze or a soft clean cloth in it. Gently wring out the cloth and apply to the sunburned area for 15-20 minutes. Change or refresh the cloth and solution every 2-3 hours.
  • Aloe Vera gel or aloe-based lotions may soothe irritated skin. These can be found in the drugstore.
  • Cool (not ice cold) baths may help. Avoid bath salts, oils, and perfumes because these may produce sensitivity reactions. Avoid scrubbing the skin or shaving the skin. Use soft towels to gently dry the body. Don't rub. Use a light, fragrance-free skin moisturizer.
  • Stay out of the sun while you are sunburned.
  • Stay hydrated to avoid dehydration.

What Is the Medical Treatment for Sunburn?

The medical treatment for sunburn is similar to the home remedies. They are all designed to decrease inflammation and pain.

  • If the patient's case is mild and not life-threatening, the doctor may suggest plenty of fluids, aspirin, or other nonsteroidal anti-inflammatory medications (NSAIDs).
  • Additional topical measures such as cool compresses, Burow's solution soaks, or high-quality moisturizing creams and lotions may be recommended.
  • If the patient's case is severe enough, oral steroid therapy (cortisone-like medications) may be prescribed for several days. Steroid creams placed on the skin show minimal to no benefit for sunburn, but may be helpful for sun rash. Consult a physician.
  • Stronger pain-relieving medication may be prescribed in certain cases.
  • If the patient has blistering, steroids may be withheld to avoid an increased risk of infection. If the patient is dehydrated or suffering from heat stress, IV fluids will be given, and the person may be admitted to the hospital. People with very severe cases may be transferred to a hospital burn unit.
  • Silver sulfadiazine (1% cream, Thermazene) can be used for treatment of sunburn. Do not use on the face.

Sunburn Follow-up

The doctor either will schedule a follow-up visit at the time of the person's initial evaluation and treatment or will give instructions to return if certain problems occur. Severe or painful sunburn can cause lost workdays. Furthermore, sunburn can cause premature aging and skin cancers.

How Do You Prevent a Sunburn?

The best prevention is to avoid the sun. This is often not practical or desired.

  • Avoid the sun during the peak hours of 10 a.m. to 2 p.m.
  • Wear wide-brimmed hats, long-sleeved shirts, long pants, and sunglasses with appropriate UV protection.
  • Sunscreens and sun protection
    • Use sunblock. Pay attention to the sun protection factor (SPF) and whether or not PABA (para amino benzoic acid) is in the product. Some people's skin is sensitive to PABA. PABA should be avoided in children younger than 6 months because it can cause skin irritation. Because of the tendency to produce irritation, most sunscreens no longer contain this chemical.
    • The higher the SPF number, the more protection the sun-blocking agent may have. SPF is actually a ratio of the time it takes to produce a skin reaction on protected and unprotected skin. Thus, a 30 SPF sunscreen would in theory allow a person to be exposed 30 times longer than with no sunscreen. However, this is usually not true in practice because the amount of sun exposure depends upon a number of factors including the length of exposure, time of day, geographic location, and weather conditions.
    • The American Academy of Dermatology recommends a "broad-spectrum" (UVA and UVB) waterproof sunscreen of at least SPF 30 be used year-round.
    • As of 2012 the Food and Drug Administration (FDA) requires the industry to label sunscreen to include protective potential against both UVA and UVB radiation. UVA radiation (previously not included in labeling) is responsible for a significant portion of sun damage. Manufacturers are no longer permitted to claim sunscreens are "waterproof" or "sweatproof" or identify their products as "sunblocks." Water resistant sunscreen claims must have information in regard to how much time a person can expect to have the declared SPF level of protection while sweating or swimming.
    • People seldom apply enough sunscreen and rarely reapply it. Sunscreen should be applied in generous amounts in layers and reapplied after being exposed.
    • The American Academy of Dermatology recommends using at least a shot glass worth of sunscreen and reapplying every 2 hours.
    • Use lip balm with SPF 30. Sweating and swimming degrade the effectiveness of sunscreen.
    • Not all sunscreens are water resistant, and even those that are still need to be reapplied regularly.
  • Certain drugs can sensitize the skin to radiation injury. Avoid the sun if taking these drugs. A doctor or pharmacist can further advise you about your medications and sun sensitivity.
    • Most likely to cause sun sensitivity are antibiotics, antipsoriatics (prescribed for skin conditions), and acne medicines.
    • The herbal drug, St. John's wort, is also thought to make a person more vulnerable to sunburn.
  • Mind-altering drugs (including alcohol) can diminish a person's awareness of getting sunburned and should be avoided.
  • Short and sequential exposure times can lead to skin pigment changes, which most of us call tanning. This can lead to increased sun tolerance but can also lead to long-term problems such as skin cancer. Getting a tan is often a primary reason people go out in the sun with maximum skin exposed in the first place.
  • Sunburn is most common in children and younger adults.
  • Avoid tanning beds entirely. Users of indoor tanners are more likely to develop melanoma than non-users. Those who use indoor tanners are also 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.

Important Areas to Cover to Avoid Sunburn

It is also important to remember to cover all areas of the body with sunblock or protective clothing. The following spots are commonly missed, which can result in painful sunburn in those areas. Pay special attention to cover:

  • Lips
  • Ears
  • Around the eyes
  • Neck
  • Hands
  • Feet
  • Scalp (if hair is thinning)
  • The bikini or bathing suit line

What Is the Prognosis for Sunburn?

  • Minor and uncomplicated cases of sunburn cause discomfort and no long-lasting effects. A person can expect to feel better in 4-7 days. The affected individual may see skin loss or peeling. This is often associated with severe itching, especially at night, after sweating, or after showering.
  • Other skin problems, such as herpes simplex, lupus, and porphyria (an inherited disorder of sensitivity to sunlight) may worsen with increased sun exposure.
  • Chronic sun exposure may lead to premature aging, severe wrinkling, pigmented skin lesion development (moles), and various malignant (cancerous) skin tumors. Premature cataract formation in the eye can also result.
Reviewed on 5/15/2018

Medically reviewed by Joseph Palermo, MD; Internal Medicine/Geriatric Medicine

REFERENCES:

American Academy of Dermatology. Sunscreens.

FDA.gov. FDA Sheds Light on Sunscreens.

skincancer.org. Facts about Sunburn and Skin Cancer.

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