Sunburn Treatment & Management

  • Author: Christopher M McStay, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 18, 2010
 

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.
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Emergency Department Care

  • Most sunburns, while painful, are not life threatening, and treatment is primarily symptomatic.[7]
  • 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.[7, 19]
  • Fluid replacement (oral or intravenous) for severe erythema or concomitant fluid loss.[20]
  • Studies of emollients such as aloe vera have failed to demonstrate decreased recovery times, but these treatments may help with sunburn symptoms.[21]
  • 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).[7] Although this is described in the literature, currently, there is no evidence to support this practice.[21]
    • Prescribe steroids for only a few days, with no need for a taper.
    • In the presence of partial-thickness (second-degree) burn, steroids are best avoided because they increase the risk of infection.
    • Topical steroids show minimal, if any, benefit.[7, 22]
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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.
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Contributor Information and Disclosures
Author

Christopher M McStay, MD  Assistant Professor, Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center

Christopher M McStay, MD is a member of the following medical societies: American College of Emergency Physicians and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ershad Elahi, MD  Resident Physician, Department of Emergency Medicine, Bellevue Hospital Center, New York

Disclosure: Nothing to disclose.

Specialty Editor Board

James Li, MD  Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

A Antoine Kazzi  MD, Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Amy Caron, MD, to the development and writing of this article.

References

  1. Kochevar IE, Taylor CR. Photophysics, photochemistry and photobiology. In: Freedberg IM, ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003:1267-1275.

  2. 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.

  3. 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].

  4. 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].

  5. Clydesdale GJ, Dandie GW, Muller HK. Ultraviolet light induced injury: immunological and inflammatory effects. Immunol Cell Biol. Dec 2001;79(6):547-68. [Medline].

  6. 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].

  7. 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.

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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.

  13. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. Jun 1988;124(6):869-71. [Medline].

  14. Lowe NJ. An overview of ultraviolet radiation, sunscreens, and photo-induced dermatoses. Dermatol Clin. Jan 2006;24(1):9-17. [Medline].

  15. 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].

  16. 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.

  17. Hatch KL, Osterwalder U. Garments as solar ultraviolet radiation screening materials. Dermatol Clin. Jan 2006;24(1):85-100. [Medline].

  18. 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].

  19. Bickers DR. Sun-induced disorders. Emerg Med Clin North Am. Nov 1985;3(4):659-76. [Medline].

  20. 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].

  21. Han A, Maibach HI. Management of acute sunburn. Am J Clin Dermatol. 2004;5(1):39-47. [Medline].

  22. 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].

  23. 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].

  24. 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].

  25. Gasparro FP, Brown D, Diffey BL, Knowland JS, Reeve V. Sun protective agents: formulations, effects and side effects. In: Freedberg IM, ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003:2344-2352.

  26. 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].

  27. Maier T, Korting HC. Sunscreens - which and what for?. Skin Pharmacol Physiol. Nov-Dec 2005;18(6):253-62. [Medline].

  28. Hawk JLM, Norris PG, Honigsmann H. Abnormal responses to ultraviolet radiation: idiopathic, probably immunologic, and photoexacerbated. In: Freedberg IM, ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003:1290-1295.

  29. Wightman JM, Hamilton GC. Red and painful eye. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006:294.

 
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Note the apoptotic sunburn cells in the epidermis. Photograph courtesy of David Shum, MD, Division of Dermatology, University of Western Ontario.
Acute sunburn of face after a soccer match in a 15 year-old female.
Subacute sunburn of shoulder with peeling in a 21-year-old male.
Table. Fitzpatrick Skin Types and Recommended Sunscreen Sun Protection Factor (SPF) Levels[13, 2, 14]
Skin Type Description Skin Color Routine SPF SPF for Outdoor Activity
IAlways burns, never tansWhite1525-30
IIAlways burns, tans minimallyWhite12-1525-30
IIIBurns minimally, tans slowlyWhite8-1015
IVBurns minimally, tans wellOlive6-8 15
VRarely burns, tans profusely/darklyBrown6-815
VIRarely burns, always tansBlack6-815
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