What are the other Names for this Condition? (Also known as/Synonyms)

• Acute Inflammatory Erythema from Sun
• Erythema Solare

What is Sunburn? (Definition/Background Information)

• Sunburns occur following an exposure to ultraviolet (UV) light, either from the sun or from any other artificial source (such as from tanning parlors or medical light treatments)
• It is caused by a reaction of the skin to UV light, resulting in the release of certain chemicals that causes red skin, pain, itching, and other signs and symptoms
• Some individuals have a greater sensitivity to UV light than others. The affected regions typically include, body areas exposed to the sun, such as the face, neck, bald portion of the scalp, hands, and the chest
• Sunburns are treatable using topical creams and steroids, oral medications, and intravenous fluids
• The prognosis with adequate treatment is usually excellent. Extensive and severe Sunburns can be life-threatening

Who gets Sunburn? (Age and Sex Distribution)

• Sunburns may be observed in all those who are exposed to ultraviolet light (either from the sun or from other sources). There is no age, gender, race, or ethnic preference observed
• Light-skinned individuals (such as Caucasians) are more prone to Sunburns than dark-skinned individuals (such as Africans or Asians)
• Latitudes around tropical areas and at higher altitudes have a higher flux of ultraviolet rays which cause Sunburn. Reflections off water and ice/snow increase light radiation doses

What are the Risk Factors for Sunburn? (Predisposing Factors)

The risk factors for Sunburns include:

• Exposure to intense sun for long periods during the course of work, or due to participation in outdoor sports and other activities
• Those who work outdoors when sun intensity is at its highest; the sun is a big source of ultraviolet light and the highest exposure occurs around noon
• People living in tropical or subtropical geographical regions
• Those with sensitive skin, who get easily sunburned
• The presence of snow or ice may increase the reflective component of sun’s UV light
• Fairer-skinned individuals have a greater risk of Sunburns than darker-toned individuals
• Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Sunburn? (Etiology)

• Sunburns are caused when skin cells (the keratinocytes that form the epidermis)  are damaged from exposure to the ultraviolet (UV) component of the sun
• UV radiation with skin interaction releases certain chemical substances, such as serotonin, prostaglandins, tumor necrosis factor alpha, and cytokines. These chemicals cause redness of skin and other associated signs and symptoms of Sunburns
• The source of UV may be from lamps and other such devices. Their effect on the skin may cumulatively add-up
• Sometimes, individuals working in certain industries may be exposed to chemicals or X-rays for a long duration. This may also contribute to the formation of this skin condition
• Contrary to popular belief, dark-skinned individuals can also get severe cases of Sunburn. The severity depends upon the amount of UV light exposure and one’s susceptibility to Sunburns

What are the Signs and Symptoms of Sunburn?

The main indication of Sunburn is a visible change in the skin color and appearance. Typically, only the outer layer of skin (the epidermis) is involved. The signs and symptoms usually begin 6 hours after UV exposure and these include:

• Tender skin
• The skin can become red (erythematous) with the formation of vesicles and bullae (fluid-filled bubbles)
  • The bullae may burst over time leaving crusted skin
  • The skin may peel and shed, as new skin forms over the damaged skin
• Pain, pain on touch
• Itching, which can be intense at times
• These signs and symptoms occur on skin areas that have been exposed to the ultraviolet light. Generally, non-exposed areas do not show these features
• Typical body regions affected include: Face and lips, hairless portion of the scalp, neck, arms (hand, forearm), and chest
• Fever and chills
• Body aches and headaches

How is Sunburn Diagnosed?

A diagnosis of Sunburn is made by:

• Physical examination of  the skin (lesion) and medical history evaluation is usually sufficient to arrive at a diagnosis
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A skin biopsy is usually unnecessary and is not performed in most cases.

Some conditions can have similar signs and symptoms to that of Sunburns. These conditions may have to be excluded to establish a diagnosis. Such conditions include:

• Systemic lupus erythematosus (SLE)
• Drug-induced phototoxicity
• Certain types of porphyrias

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Sunburn?

The possible complications due to Sunburns may include:

• Discomfort, irritability of the affected skin
• Secondary or superimposed infections due to bacteria or fungus, particularly if the blisters are picked or scratched
• Activation of herpes simplex virus on skin affected by the burn
• Sunburned skin permits increased cutaneous water loss, with dehydration risk
• With extensive severe Sunburn, fluid and electrolyte management and pain can be severe enough that admission to a burn unit is needed
• The affected areas can heal with either increased or decreased pigmentation
• Longstanding Sunburns and cumulative non-Sunburn sun damage can result in the development of basal cell or squamous cell carcinomas (common types of skin cancers)

How is Sunburn Treated?

Commencing early treatment can help prevent progressive worsening of Sunburns and avoid complications. Several treatment measures are available and these include:

• Moving away from hot locations; cooling the affected area with cold running water (and not with ice)
• Hydration with appropriate fluids containing electrolytes
• Topical treatment includes cooling the skin using moist towels and moisturizing creams to soothe the condition
  • Use of topical ointments, lotions, and creams - these may be antiseptic and anti-inflammatory applications
  • Creams containing aloe vera should be considered
  • Creams containing petroleum products should be generally avoided, since it can worsen the condition in some individuals
  • Topical steroidal creams can help reduce inflammation
• Systemic treatment may be required in some cases
  • It may include medications, such as aspirin and other non-steroidal anti-inflammatory over-the-counter painkillers
  • In severe cases of Sunburns, oral steroids and IV fluids may be necessary

How can Sunburn be Prevented?

A few methods to prevent Sunburns include:

• Avoid prolonged and chronic exposure to the sun. If this is unavoidable (like due to an occupational requirement), then take safety steps to reduce exposure to the UV rays, by using sunscreens with high sun-protection factor, wide brimmed hats and protective clothing
• Be aware of the hazards of prolonged sun exposure and take steps to protect yourself. Modify your profession to stay out of the sun during the period, when it is the most intense
• Avoid excessive sunbathing (particularly if you are fair-skinned), use of tanning beds, sun lamps, and chemical agents, that accelerate sun tanning
• Individuals who are regularly exposed to the sun, or work under the sun should get their skin periodically examined by a physician. This is crucial if they suspect, or if there are any noticeable skin changes
• Keep yourself well-hydrated, if sun-exposure for prolonged periods is unavoidable

What is the Prognosis of Sunburn? (Outcomes/Resolutions)

• The prognosis of Sunburns is excellent with appropriate treatment. Typically, the skin on healing does not scar or result in hair loss, even if the condition is severe
• However, Sunburns can recur on exposure to ultraviolet radiation again
• There is a rare chance that some of the lesions may develop to form invasive skin cancers, when chronic sun exposure and other risk factors are high

An Australian study showed severe Sunburns before age 10 years is a risk factor for melanoma later in life.

Additional and Relevant Useful Information for Sunburn:

Do not pick or pop the blisters, for doing so can affect the healing process and may result in secondary infections.