Further Inpatient Care
- Inpatient care is indicated for severe burns, secondary infection, or control of severe pain.
- Indications for admission to a dedicated burn unit are the same as those for thermal burns (see Transfer).
Further Outpatient Care
- Outpatient care is indicated for most cases of sunburn.
- Cool baths or showers
- Anti-inflammatory/analgesic medications
- Avoidance of further sun exposure[7]
Inpatient & Outpatient Medications
Topical anesthetic sprays or creams may cause sensitization and consequent dermatitis and, therefore, should be avoided.[20]
Transfer
Indication for transfer to a burn unit are the same as for thermal burns (second-degree burns covering 25% of total body surface area in adults or 20% of total body surface area in patients aged < 10 y or >50 y).[16] Other criteria exist for body parts affected, please refer to Burns, Thermal for a discussion of deeper thermal burns.
Deterrence/Prevention
- Prevention is the most effective therapy for sunburn. Individual and community educational programs can be effective in decreasing overall sun exposure or increasing use of sunscreen or protective clothing.[23, 24]
- Avoid sun exposure, especially during the period of peak solar radiation (from 10 am to 4 pm).[9]
- Regularly use sunscreen with an adequate SPF for a given skin type.
- SPF is the ratio of the amount of UV energy needed to produce erythema on protected skin to the amount of UV energy needed to produce erythema on unprotected skin.[25]
- Refer to the Table for recommended sunscreen levels for everyday protection and outdoor activity protection.
- Apply at least 30 minutes prior to sun exposure, and reapply every 2-3 hours or after swimming, sweating, or toweling off.[25]
- Apply for young children prior to exposure.
- Use waterproof sunscreen when swimming or perspiring heavily.[25]
- Apply at least 2 mg/cm2 of sunscreen to achieve the advertised SPF (about 30 mL is adequate coverage for an average adult's entire body). Most people apply one fifth of this amount.[26]
- Physical barriers (eg, zinc oxide, titanium dioxide) provide excellent protection against UVA and UVB and are photostable.[14]
- Chemical barriers are used in most sunscreens. Para-aminobenzoic acid (PABA) and PABA esters, UVB blockers, have fallen out of favor because of high rates of associated contact dermatitis and clothing staining. Other chemical UVB blocking agents include cinnamates and salicylates.[14]
- Chemical UVA blockers include avobenzone (Parsol 1789) and the recently FDA-approved drometrizole trisiloxane and terephthalylidene (Mexoryl).[27]
- Wear protective clothing, including wide-brimmed hat or sun visor. Clothing can be treated with over-the-counter products to increase the SPF.[17]
- Specialized sun-protective clothing is available and usually states the SPF each garment affords.
Complications
- Sunburns may exacerbate chronic diseases such as chronic actinic dermatitis, herpes simplex, eczema, and lupus erythematosus.[28]
- Sunburns may be associated with other heat-related illnesses, including dehydration, heat exhaustion, and heatstroke.
- Long-term exposure of the skin can lead to multiple deleterious effects, including premature aging and wrinkling of the skin (dermatoheliosis), development of premalignant lesions (solar keratoses), and development of malignant tumors (eg, basal cell carcinoma, squamous cell carcinoma, melanoma).[2]
- Patients with sunburn may be at risk for UV keratitis.[29]
Prognosis
Uncomplicated cases of sunburn resolve spontaneously over 4-7 days with scaling and desquamation but without acute sequelae.[7]
Patient Education
- Educate patients on the short- and long-term complications (see Complications).
- Educate patients on prevention of sunburn (see Deterrence/Prevention).
- For excellent patient education resources, visit eMedicine's Burns Center. Also, see eMedicine's patient education article Sunburn.
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Walker SL, Hawk JL, Young AR. Acute effects of ultraviolet radiation on the skin. In: Freedberg IM, ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003:1275-1282.
Walsh LJ. Ultraviolet B irradiation of skin induces mast cell degranulation and release of tumour necrosis factor-alpha. Immunol Cell Biol. Jun 1995;73(3):226-33. [Medline].
Terui T, Takahashi K, Funayama M, Terunuma A, Ozawa M, Sasai S, et al. Occurrence of neutrophils and activated Th1 cells in UVB-induced erythema. Acta Derm Venereol. Jan-Feb 2001;81(1):8-13. [Medline].
Clydesdale GJ, Dandie GW, Muller HK. Ultraviolet light induced injury: immunological and inflammatory effects. Immunol Cell Biol. Dec 2001;79(6):547-68. [Medline].
Van Laethem A, Claerhout S, Garmyn M, Agostinis P. The sunburn cell: regulation of death and survival of the keratinocyte. Int J Biochem Cell Biol. Aug 2005;37(8):1547-53. [Medline].
Kramer DA, Shayne P. Sun-induced disorders. In: Schwartz GR, ed. Principles and Practice of Emergency Medicine. 4th ed. Baltimore, MD: Lippincott Williams & Wilkins; 1999:1581.
Narbutt J, Lesiak A, Sysa-Jedrzejowska A, Boncela J, Wozniacka A, Norval M. Repeated exposures of humans to low doses of solar simulated radiation lead to limited photoadaptation and photoprotection against UVB-induced erythema and cytokine mRNA up-regulation. J Dermatol Sci. Mar 2007;45(3):210-2. [Medline].
Centers for Disease Control and Prevention (CDC). Sunburn prevalence among adults--United States, 1999, 2003, and 2004. MMWR Morb Mortal Wkly Rep. Jun 1 2007;56(21):524-8. [Medline]. [Full Text].
Brown TT, Quain RD, Troxel AB, Gelfand JM. The epidemiology of sunburn in the US population in 2003. J Am Acad Dermatol. Oct 2006;55(4):577-83. [Medline].
Cokkinides V, Weinstock M, Glanz K, Albano J, Ward E, Thun M. Trends in sunburns, sun protection practices, and attitudes toward sun exposure protection and tanning among US adolescents, 1998-2004. Pediatrics. Sep 2006;118(3):853-64. [Medline].
Ultraviolet radiation: global solar UV index. Fact sheet No. 271. August 2002. World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs271/en/index.html.
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. Jun 1988;124(6):869-71. [Medline].
Lowe NJ. An overview of ultraviolet radiation, sunscreens, and photo-induced dermatoses. Dermatol Clin. Jan 2006;24(1):9-17. [Medline].
Mukamal KJ. Alcohol consumption and self-reported sunburn: a cross-sectional, population-based survey. J Am Acad Dermatol. Oct 2006;55(4):584-9. [Medline].
Edlich RF, Martin ML, Long WB. Thermal burns. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006:918-9.
Hatch KL, Osterwalder U. Garments as solar ultraviolet radiation screening materials. Dermatol Clin. Jan 2006;24(1):85-100. [Medline].
Moehrle M, Koehle W, Dietz K, Lischka G. Reduction of minimal erythema dose by sweating. Photodermatol Photoimmunol Photomed. Dec 2000;16(6):260-2. [Medline].
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Rapaport MJ, Rapaport V. Preventive and therapeutic approaches to short- and long-term sun damaged skin. Clin Dermatol. Jul-Aug 1998;16(4):429-39. [Medline].
Han A, Maibach HI. Management of acute sunburn. Am J Clin Dermatol. 2004;5(1):39-47. [Medline].
Faurschou A, Wulf HC. Topical corticosteroids in the treatment of acute sunburn: a randomized, double-blind clinical trial. Arch Dermatol. May 2008;144(5):620-4. [Medline].
Dietrich AJ, Olson AL, Sox CH, Stevens M, Tosteson TD, Ahles T, et al. A community-based randomized trial encouraging sun protection for children. Pediatrics. Dec 1998;102(6):E64. [Medline].
Norman GJ, Adams MA, Calfas KJ, Covin J, Sallis JF, Rossi JS, et al. A randomized trial of a multicomponent intervention for adolescent sun protection behaviors. Arch Pediatr Adolesc Med. Feb 2007;161(2):146-52. [Medline].
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Autier P, Boniol M, Severi G, Dore JF,. Quantity of sunscreen used by European students. Br J Dermatol. Feb 2001;144(2):288-91. [Medline].
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| Skin Type | Description | Skin Color | Routine SPF | SPF for Outdoor Activity |
| I | Always burns, never tans | White | 15 | 25-30 |
| II | Always burns, tans minimally | White | 12-15 | 25-30 |
| III | Burns minimally, tans slowly | White | 8-10 | 15 |
| IV | Burns minimally, tans well | Olive | 6-8 | 15 |
| V | Rarely burns, tans profusely/darkly | Brown | 6-8 | 15 |
| VI | Rarely burns, always tans | Black | 6-8 | 15 |
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