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.
Medical Care
Most sunburns, while painful, are not life threatening, and treatment is primarily symptomatic. [8]
Nonsteroidal anti-inflammatory drugs (NSAIDs) have antiprostaglandin effects and may relieve pain and inflammation, especially when given early. However, NSAIDs do not shorten the duration of sunburn. [24]
Cool soaks with water or Burrow solution (aluminum acetate solution) also provide temporary relief. [8, 25]
Fluid replacement (oral or intravenous) for severe erythema or concomitant fluid loss. [26]
Studies of emollients such as aloe vera have failed to demonstrate decreased recovery times, but these treatments may help with sunburn symptoms. [27]
Topical anesthetic sprays or creams may cause sensitization and consequent dermatitis and, therefore, should be avoided. [26]
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. [27]
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 have not shown any clinical benefit when applied after UV exposure. [8, 28]
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. 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). [20] Other criteria exist for body parts affected, please refer to Thermal Burns for a discussion of deeper thermal burns.
Outpatient care, with the following, is indicated for most cases of sunburn:
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Cool baths or showers
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Anti-inflammatory/analgesic medications
-
Avoidance of further sun exposure [8]
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.
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. [29, 30]
Avoid sun exposure, especially during the period of peak solar radiation (from 10 am to 4 pm). [13]
Regularly use sunscreen with an adequate sun protection factor (SPF) for a given skin type. Note the following:
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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. [31]
-
Refer to the Table for recommended sunscreen levels for everyday protection and outdoor activity protection.
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Apply at least 30 minutes prior to sun exposure, and reapply every 2-3 hours or after swimming, sweating, or toweling off. [31]
-
Apply for young children prior to exposure.
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Use waterproof sunscreen when swimming or perspiring heavily. [31]
-
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. [32]
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Physical barriers (eg, zinc oxide, titanium dioxide) provide excellent protection against UVA and UVB and are photostable. [17]
-
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. [17]
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Chemical UVA blockers include avobenzone (Parsol 1789) and the recently FDA-approved drometrizole trisiloxane and terephthalylidene (Mexoryl). [33]
Wear protective clothing, including wide-brimmed hat or sun visor. Clothing can be treated with over-the-counter products to increase protection from UV radiation. [21]
Specialized sun-protective clothing is available and usually states the SPF each garment affords.
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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 |
