Sunburn

DEFINITION

• Red, painful skin following sun exposure

General Information

• Most sunburn is a first-degree burn that turns the skin pink or red. Prolonged sun exposure can cause blistering (a second-degree burn). Sunburn never causes a third-degree burn or scarring.
• The pain and swelling starts at 4 hours, peaks at 24 hours, and improves after 48 hours.
• Long-term sun exposure increases the risk of skin cancer and causes aging of the skin.

See More Appropriate Topic (instead of this one) If

• Chemical or thermal burn, see BURNS

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Passed out (fainted)
• Difficult to awaken or acting confused
• Very weak (unable to stand)

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Unable to look at lights because of eye pain
• Looks infected (e.g., draining pus, red streaks, increasing tenderness after day 2)
• Extremely painful sunburn, and not improved after taking pain medication

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

• You think you need to be seen
• Many small blisters are present
• Blisters are present on face
• Blister larger than 1 inch (2.5 cm)

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Mild sunburn and you don't think you need to be seen
• Sunscreen and protection from the sun, questions about

HOME CARE ADVICE

Home Care Advice for Sunburn

1. Ibuprofen for Pain: For pain relief, begin taking ibuprofen (e.g. Advil, Motrin) as soon as possible. Adult dosage is 400 mg every 6 hours.  If anti-inflammatory agents such as ibuprofen are begun within 6 hours of sun exposure and continued for 2 days, they can greatly reduce your discomfort. If you can't take ibuprofen, use acetaminophen (e.g. Tylenol) instead.
   • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
2. Hydrocortisone Cream: Apply 1% hydrocortisone cream as soon as possible and then three times a day for two days. If begun early, it may reduce swelling and pain.  If you don't have any hydrocortisone cream, use a moisturizing cream until you can get some. 
   • Keep the cream in the refrigerator (Reason: it feels better if applied cold)
   • Available over-the-counter in U.S. as 0.5% and 1% cream.
   • Available over-the-counter in Canada as 0.5% cream.
3. Cool Baths: Apply cool compresses to the burned area several times a day to reduce pain and burning. For larger sunburns, give cool baths for 10 minutes (caution: avoid any chill). Add 2 oz. baking soda per tub. Avoid soap on the sunburn.
4. Extra Fluids: Drink extra water on the first day to replace the fluids lost into the sunburn and to prevent dehydration and dizziness.
5. Broken Blisters:
   • For broken blisters, trim off the dead skin with a fine scissors. (Reason: these hidden pockets can become a breeding ground for infection.)
   • Apply antibiotic ointment (e.g. Bacitracin) to the raw skin under broken blisters. Reapply twice daily for 3 days.
   • Caution: leave intact blisters alone. (Reason: the intact blister protects the skin and allows it to heal.)
6. Expected Course: Pain usually stops after 2 or 3 days.  Skin flaking and peeling usually occur 5-7 days after the sunburn.
7. Call Your Doctor If:
   • Pain becomes severe and not improved after taking pain medication
   • Pain does not improve after 3 days
   • Sunburn looks infected
   • You become worse

How to Prevent Sunburn

1. Prevention - Reduce Sun Exposure:
   • Try to avoid all sun exposure between 10 am and 3 pm.
   • You can get a sunburn while swimming. Water only blocks the ultraviolet radiation a little.

2. Prevention - Clothing:

   • Wear a wide-brim hat; it protects your face and neck from the sun.
   • Wear shirts with long sleeves when outdoors and pants that go down to at least your ankles.
3. Prevention - Use Sunscreen:
   • Apply sunscreen to areas that can't be protected by clothing. Generally, an adult needs about 1 oz of sunscreen lotion to cover the entire body.
   • You should reapply the sunscreen every 2-4 hours. You should also reapply after swimming, exercising, or sweating.
   • A sunscreen with a rating of SPF 15 to 30 should be used. Sunscreens with ratings higher than 30 provide minimal additional protection.
   • Sunscreens help prevent sunburn, but do not completely prevent skin damage. Thus, sun exposure can still increase your risk of skin aging and skin cancer.
4. Vitamins C and E: Vitamins C and E have anti-oxidant properties, which means they help prevent sun damage to cells in your skin. Taking vitamins C and E by mouth may partially reduce the sunburn reaction.
   • The adult dosage of vitamin C (ascorbic acid): 2 grams by mouth once a day.
   • Adult dosage of vitamin E (d-alpha-tocopherol): 1000 IU by mouth once a day.
   • Caution: Prevention is the key. Remember to reduce sun exposure and use sunscreens.
   • Read the package instructions thoroughly on all medications that you take.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.