History
History and symptoms for sunburn may include the following:
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Recent sun exposure or outdoor activity; outdoor occupations or hobbies; use of indoor tanning equipment
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Erythema develops after 3-4 hours and peaks at 12-24 hours. [8]
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Pain
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Possible fever, chills, malaise, nausea, or vomiting in severe cases
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Blistering
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Erythema that resolves over 4-7 days, usually with skin scaling and peeling [8] (See the image below.)
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Assess for exposure to photosensitizing drugs. See Medscape Reference article Drug-Induced Photosensitivity for an in-depth discussion and list of common photosensitizing drugs.
Physical Examination
Patients at highest risk typically have fair skin, blue eyes, and red or blond hair. [10]
The acute inflammatory response, with the following, is greatest 12-24 hours after exposure [8] :
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Erythema
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Warmth
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Tenderness
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Edema
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Blistering (severe cases), a sign of either a superficial partial-thickness or deep partial-thickness (second-degree) burn [20]
Fever can present in severe cases. [8]
UVR may be transmitted through clothing, especially when wet, so sunburn may occur under clothed skin. [21]
Delayed scaling and desquamation occurs 4-7 days after exposure. [8]
Complications
Sunburns may exacerbate chronic diseases such as chronic actinic dermatitis, herpes simplex, eczema, and lupus erythematosus. [18]
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] A history of severe sunburn is associated with an increased risk of melanoma and other skin cancers, particularly in men. [22]
Patients with sunburn may be at risk for UV keratitis. [23]
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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.
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Acute sunburn of face after a soccer match in a 15 year-old female.
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Subacute sunburn of shoulder with peeling in a 21-year-old male.
Tables
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 |
