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Sunburn: Treatment & Medication
Updated: Apr 14, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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Treatment
Prehospital Care
- In most cases, prehospital care involves providing simple first aid to treat patient symptoms.
- In severe cases, patients may develop second-degree burns, which could require aggressive fluid resuscitation and skin care.
Emergency Department Care
- Most sunburns, while painful, are not life threatening, and treatment is primarily symptomatic.8
- Nonsteroidal anti-inflammatory drugs (NSAIDs) have antiprostaglandin effects and are useful to relieve pain and inflammation, especially when given early. Cool soaks with water or Burrow solution (aluminum acetate solution) also provide temporary relief.8,20
- Fluid replacement (oral or intravenous) for severe erythema or concomitant fluid loss.21
- Studies of emollients such as aloe vera have failed to demonstrate decreased recovery times, but these treatments may help with sunburn symptoms.22
- Systemic steroids are sometimes used to shorten the course and to reduce the pain of sunburn when given early and in relatively high doses (equivalent to 40-60 mg/d of prednisone).8 Although this is described in the literature, currently, there is no evidence to support this practice.22
Consultations
- Consult a dermatologist if the diagnosis of sunburn is in doubt or for children who appear to burn easily. In the latter case, a more serious underlying disorder may be present.
- Severe cases may require consultation with pediatricians or internists for hospital admission. Patients rarely require care in a dedicated burn unit.
Medication
The symptoms of minor sunburn can be relieved to some extent with cool compresses or a cool bath. Administration of nonprescription analgesics and NSAIDs for the treatment of pain and inflammation is recommended.
Analgesic Nonsteroidal Anti-inflammatory Drug
These medications can reduce the pain and inflammation associated with sunburn.
Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Adult
500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
Aspirin (Bayer, Anacin, Bufferin)
Used for the treatment of mild to moderate pain. Also acts on the hypothalamus heat-regulating center to reduce fever.
Adult
650 mg PO bid/qid; not to exceed 4 g/d in equally divided doses
Pediatric
10-15 mg/kg/dose PO q4-6h; not to exceed 60-80 mg/kg/d
Effects may decrease with antacids and urinary alkalinizers; corticosteroids decrease salicylate serum levels; additive hypoprothrombinemic effects and increased bleeding time may occur with coadministration of anticoagulants; may antagonize uricosuric effects of probenecid and increase toxicity of phenytoin and valproic acid; doses >2 g/d may potentiate glucose-lowering effect of sulfonylurea drugs
Documented hypersensitivity; liver damage; hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma; children (<16 y) with flu (because of association with Reye syndrome)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
May cause transient decrease in renal function and aggravate chronic kidney disease; avoid use in patients with severe anemia, in those with history of blood coagulation defects, or in those taking anticoagulants
Ibuprofen (Advil, Motrin, Nuprin)
Usually the DOC for the treatment of mild to moderate pain, if no contraindications are present.
Adult
200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d
Pediatric
30-70 mg/kg/d PO tid/qid
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy
Analgesic, Miscellaneous
These agents are used to decrease the pain associated with sunburn.
Acetaminophen (Tylenol, Aspirin-Free Anacin, Feverall, Tempra)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, in those with upper GI disease, or in those who are taking oral anticoagulants.
Effective in relieving mild to moderate acute pain; however, has no peripheral anti-inflammatory effects. May be preferred in elderly patients because of fewer GI and renal side effects.
Adult
325-650 mg PO/PR q4-6h or 1000 mg tid/qid; not to exceed 4 g/d
Pediatric
<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4h; not to exceed 4 g/d
Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Documented hypersensitivity; known G-6-PD deficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity possible in chronic alcoholics following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; contained in many OTC products and combined use with these products may result in toxicity due to cumulative doses exceeding recommended maximum dose
Corticosteroids
Because they modify the body's immune response, corticosteroids are thought to decrease erythema and shorten the course of sunburn.
Prednisone (Deltasone, Orasone, Meticorten)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Adult
40-60 mg PO qd
Pediatric
1 mg/kg PO qd
Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral, fungal, tubercular skin, connective tissue infections; peptic ulcer disease; hepatic dysfunction; GI disease
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use
More on Sunburn |
| Overview: Sunburn |
| Differential Diagnoses & Workup: Sunburn |
 Treatment & Medication: Sunburn |
| Follow-up: Sunburn |
| Multimedia: Sunburn |
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References
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Further Reading
Keywords
sunburn, sun burn, erythema solare, ultraviolet radiation, UVR, solar erythema, first-degree burn, superficial burn, second-degree burn, dehydration, shock, squamous cell carcinoma, basal cell carcinoma, malignant melanoma, photosensitizing drugs, blistering, UVA, UVB, minimal erythema dose, MED
