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Sunburn

Sunburns


Presentation

Sunburns are readily noticeable by their visible signs [7]. These signs include erythema which usually occurs within two to six hours after overexposure. The pain is often so intense that even a thin layer of clothing touching the skin can cause pain. It may also seem like the skin is stiff and can make moving painful or difficult.

A sunburn can also cause a fever, chills, general malaise, and even nausea, vomiting and syncope if the case is more severe. Severe cases may also create blisters which may become infected in rare cases. 

The erythema usually resolves within a few days after exposure, but scaling and desquamation may occur.

Chills
  • You may even feel like you have the flu -- feverish, with chills, nausea , headache , and weakness . A few days later, your skin will start peeling and itching as your body tries to rid itself of sun-damaged cells.[webmd.com]
  • Sunburn causes painful reddened skin and sometimes blisters, fever, and chills. People can prevent sunburn by avoiding excessive sun exposure and by using sunscreens.[merckmanuals.com]
  • Signs and Symptoms Mild: skin redness and warmth pain itchiness Severe: skin redness and blistering pain and tingling swelling headache nausea fever and chills dizziness What to Do Have your child get out of the sun right away.[kidshealth.org]
Malaise
  • A sunburn can also cause a fever, chills, general malaise, and even nausea, vomiting and syncope if the case is more severe. Severe cases may also create blisters which may become infected in rare cases.[symptoma.com]
  • Systemic symptoms can accompany severe sunburn: there may be headache, chills, malaise, nausea and vomiting. Assessment [ 2 ] As for any burn - assess the severity and area covered (see box below).[patient.info]
  • These sunburns may be accompanied by fever, headache, itching, and malaise.[wwwnc.cdc.gov]
Rigor
  • This study examines whether RTR have sufficiently rigorous sun protection behaviour compared with the general population.[ncbi.nlm.nih.gov]
  • Therefore, they are not always the same as official national estimates produced using alternate, potentially equally rigorous methods, nor necessarily endorsed by specific Member States.[who.int]
  • Normal vitamin D levels can be maintained despite rigorous photoprotection: Six years' experience with xeroderma pigmentosum.[ncbi.nlm.nih.gov]
Blister
  • If your skin blisters, allow the blisters to heal. Blistering skin means you have a second-degree sunburn. You should not pop the blisters, as blisters form to help your skin heal and protect you from infection.[aad.org]
  • Care of blisters Home treatment may help decrease pain, prevent infection, and help the skin heal. Small, unbroken blisters [less than 1 in. (2.5 cm) across] usually heal on their own. Do not try to break the blisters. Just leave them alone.[web.archive.org]
  • Unfortunately, several days before her next scheduled cycle, she developed significant sunburn (intense erythema without blistering).[ncbi.nlm.nih.gov]
  • […] do not scratch or try to remove peeling skin do not wear tight-fitting clothes over sunburnt skin You can ask a pharmacist: about the best sunburn treatments if you need to see a GP See a GP urgently or call NHS 111 if: your skin is blistered or swollen[nhs.uk]
  • Sometimes these blisters lead to skin infections that can cause more pain, swelling and a fever. Sunburn blisters often can be treated with some simple and easy home remedies.[top10homeremedies.com]
Photosensitivity
  • This reaction is distinct from true photosensitivity. Photosensitivity is listed in the drug brochure for methotrexate. However, a review of the literature does not support true photosensitivity associated with methotrexate.[ncbi.nlm.nih.gov]
  • Reaction photosensitivity (NOS) , Photosensitivity toxic reaction , Photosensitized , Dermatitis, Phototoxic [Disease/Finding] , photosensitivity reaction , photosensitizing , phototoxic dermatitis , phototoxicity , photosensitivity reactions , phototoxic[fpnotebook.com]
  • UV radiation causes acute adverse effects like sunburn, photosensitivity reactions, or immunologic suppression, as well as long-term sequelae like photoaging or malignant skin tumors.[ncbi.nlm.nih.gov]
  • Photosensitivity - for example, systemic lupus erythematosus, porphyria; drugs such as tetracyclines and many others.[patient.info]
  • , photosensitivity (sun) 692.72 plants NEC 692.6 plasters, medicated (any) 692.3 plastic 692.4 poison preservatives 692.89 primrose (primula) 692.6 primula 692.6 radiation 692.82 radioactive substance 692.82 radium 692.82 ragweed (Senecio jacobae) 692.6[icd9data.com]
Dry Skin
  • As well, the FDA says it lacks data to prove that sprays provide the necessary thick, even skin coverage on dry skin, let alone a wet kid." Until there is more research on the matter, EWG recommends using sunscreen lotion for optimal protection .[cbsnews.com]
  • When you are sunburnt, it practically means that your skin is dehydrated which ultimately results in dry skin. Be sure to apply lotion to your skin to help keep it moisturized.[sunburntreatmenthq.com]
  • Oatmeal is proven to relieve itchy dry skin and reduce inflammation as burns heal ( 2 , 3 ). Enjoy its healing effects by blending dry oats in a blender or food processor until its finely ground and smooth.[draxe.com]
  • Hydrate (and heal) dry skin Getty Images joannawnuk Moisturize strategically After you’ve rinsed off, smooth on a natural bath oil.[prevention.com]
Fair Complexion
  • Other risk factors include a fair complexion, found commonly in people with blueor green eyes, freckles, and light-colored hair (The Skin Cancer Foundation, 2008).[ncbi.nlm.nih.gov]
  • Her fair complexion now has dark marks on her face from just a few hours without sun protection. She wrote about her experience on MarieClaire.com , writing: "It was a very typical sunburn.[6abc.com]
Exanthema
  • .) , Photosensitivitasos reakció , Dermatitis photosensitiv , Photosensitiv dermatitis , Photosensitivitas toxikus reakció , Fényérzékenyített , photosensitivitasos exanthema , Photosensitiv kiütés , Photosensitivitas reakció k.m.n.[fpnotebook.com]
Hyperalgesia
  • The time course of hyperalgesia over 96 h was studied in a subgroup of 12 subjects. Within the sunburn area, cold hyperesthesia (P .01), profound generalized hyperalgesia to heat (P Copyright 2013 International Association for the Study of Pain.[ncbi.nlm.nih.gov]
Hyperesthesia
  • Within the sunburn area, cold hyperesthesia (P .01), profound generalized hyperalgesia to heat (P Copyright 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.[ncbi.nlm.nih.gov]

Workup

For uncomplicated cases, laboratory studies and imagine studies are not needed as symptoms are visible to the eyes [8].
When diagnosis is in doubt though, skin biopsy may be useful in order to exclude other diseases in the differential diagnosis.

Treatment

Sunburn treatment doesn’t heal the skin or prevent damage to the skin rather it is focused on the reduction of pain, discomfort and swelling [9]. When the condition doesn’t resolve on its own, the following may be prescribed:

  • • Over the counter prescription pain relievers help control pain and swelling associated with sunburn especially when taken immediately after exposure to sun. The most common types are ibuprofen or naproxen. Some types of pain relievers may also be applied to the skin as gels. 
  • • Corticosteroids may be prescribed as control for itching. They are often used in combination with pain relievers.

Prognosis

Normal cases of sunburn rarely develop beyond short-term cause for concern. This is because most of the cases will resolve spontaneously without any further complications [6]. In extremely rare cases however, dehydration, infection and second degree burns may arise. 

Etiology

The main cause of sunburn is too much exposure to ultraviolet light which can occur when the individual stays for too long under sunlamps, tanning beds or direct sunlight [2]. 

Epidemiology

In the United States, thousands of adults and children develop sunburns each year [3].

People living in close to the equator and in higher altitude regions are the people most at risk of sunburn.

Sex distribution
Age distribution

Pathophysiology

When the skin is exposed to the sun long enough, the individual not only enjoys radiant warmth but also vitamin D is synthesised. However, when the skin is left open to sunlight and other sources of ultraviolet rays for far too long, sunburn arises. Another common problem that sets in following excessive exposure is solar erythema.

Injury that arises as a result of excessive exposure to ultraviolet rays happen because the DNA gets damaged by ultraviolet light. When the DNA gets damaged, inflammation and apoptosis of the skin cell sets in. 

The characteristic erythema that is seen with sunburn is because the inflammation that follows sunburn often leads to a vasodilation of the cutaneous blood vessels. 

It only takes 2 hours for damage to the epidernal skin cells to be seen following excessive UV exposure. 

Prevention

Below are some measures to prevent sunburn at any point in time. However, it is very important to be careful around bodies that reflect the sun’s rays such as water, snow, ice and sand. Additionally, UV light is often more intense when around high altitudes [10].

  • • Avoid extensive exposure to the sun during peak hours by seeking shade when possible.
  • • Tightly woven clothing that covers the arm and legs are good at providing sun protection.
  • • Hats with broad brims are important as they protect the scalp and face. 
  • • Broad spectrum sunscreen of 15 or more should be used frequently and generously irrespective of skin type. 
  • • Sunscreen must be reapplied every 2 hours and must be used first before using any insect repellents.
  • • Sunscreen can only be used on babies 6 months old and above. For younger babies, it is advisable to use other forms of sun protection like seeking shade. 
  • • Glasses must be worn when outdoors. 
  • • Base tan doesn’t prevent sunburn. No research supports this so it must not be used as method of prevention against sunburn. 

Summary

Sunburn is the condition that arises when the skin is exposed too much to the sun or other sources of ultraviolet radiations such as arc lamps, tanning beds, etc. Sunburn is an inflammatory reaction and clinically, it is regarded as superficial or first degreee burns [1].

Patient Information

Sunburn happens when your skin becomes red, painful and hot when touched as a result of staying too long under ultraviolet light from the sun, sunlamps or tan beds. Sunburn often clears off on its own but may take several days.

Consistent sunburn increases the risk of your skin getting damaged and becoming vulnerable to a lot of skin diseases such as wrinkled skin, dark spots, rough spots and some type of skin cancers like melanoma.

Sunburn can however, be prevented by adequate protection of the skin when outdoors. Sunburn treatments are often easy and straightforward, not requiring much intervention from medical personnel.

References

Article

  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. Matsumura Y, Ananthaswamy HN. Toxic effects of ultraviolet radiation on the skin. Toxicol Appl Pharmacol. Mar 15 2004;195(3):298-308.
  4. 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. 
  5. 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. 
  6. Young AR. Acute effects of UVR on human eyes and skin. Prog Biophys Mol Biol 2006; 92:80.
  7. Young AR, Chadwick CA, Harrison GI, et al. The similarity of action spectra for thymine dimers in human epidermis and erythema suggests that DNA is the chromophore for erythema. J Invest Dermatol 1998; 111:982.
  8. Chang YM, Barrett JH, Bishop DT, et al. Sun exposure and melanoma risk at different latitudes: a pooled analysis of 5700 cases and 7216 controls. Int J Epidemiol 2009; 38:814.
  9. Dennis LK, Vanbeek MJ, Beane Freeman LE, et al. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol 2008; 18:614.
  10. Warthan MM, Sewell DS, Marlow RA, et al. The economic impact of acute sunburn. Arch Dermatol 2003; 139:1003.

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Last updated: 2017-08-09 18:18