Sunburn
Solar erythema; Burn from the sun
A sunburn is reddening of the skin that occurs after you are overexposed to the sun or other ultraviolet light.
The skin uses sunlight to help manufacture vitamin D, which is important for normal bone formation. But there’s a downside. The sun's ultraviolet light can cause major damage to the skin. The outer layer of the skin has cells that contain the pigment melanin. Melanin protects skin from the sun's ultraviolet rays. These can burn the skin and reduce its elasticity, leading to premature aging. People tan because sunlight causes the skin to produce more melanin and darken. The tan fades when new cells move to the surface and the tanned cells are sloughed off. Some sunlight can be good as long as you have proper protection from overexposure. But too much ultraviolet, or UV, exposure can cause sunburn. The UV rays penetrate outer skin layers and hit the deeper layers of the skin, where they can damage or kill skin cells. People, especially those who don’t have much melanin and who sunburn easily, should protect themselves. You can protect yourself by covering sensitive areas, wearing sunblock, limiting total exposure time, and avoiding the sun between 10 am and 2 pm. Frequent exposure to ultraviolet rays over many years is the chief cause of skin cancer. And skin cancer should not be taken lightly. Check your skin regularly for suspicious growths or other skin changes. Early detection and treatment are key in the successful treatment of skin cancer.
The depth of a burn determines its severity. First degree burns damage the outer layer of skin (epidermis) and cause pain, redness and swelling (erythema). Second degree burns damage the epidermis and the inner layer, the dermis, causing erythema and blistering. Damage from third degree burns extend into the hypodermis, causing destruction of the full thickness of skin with its nerve supply (numbness). Third degree burns leave scars and may cause loss of function and/or sensation.
We all know that preventing sunburn is the best. But what do you do if you get sunburn? I'm Dr. Alan Greene. Let's talk about that together. When you have a burn from the sun, a radiation burn from the sun, there are a couple of things going on. One is that there's a heat injury. The skin gets hot. You can feel it when you touch it. You can feel it in the burn itself. And another is the outer protective layer is damaged, so the skin can dry out too easily. So the keys to treating a sunburn are to keep the skin cool and moist. So, one great way to do that is with what we call a cool compress. Just take a washcloth. Put some cool water in there and press gently onto the skin. Or you might do a shower - frequent, cool, and lukewarm showers. Either way right afterwards you want to slather on a good moisturizer to try to seal some of that water in, moisture in, preferably a moisturizer that doesn't contain alcohol or any other drying agent. Another time-honored remedy is the Aloe vera plant. And there's some recent studies questioning how effective it really is, but many people swear by it. You cut a little tip off the end of the plant and that gel you rub just directly onto the sunburn itself. And it certainly feels soothing and may help beyond that. Another piece of treating sunburn is to deal with the pain and the inflammation. And for that you might try acetaminophen for the pain or ibuprofen for the pain and inflammation both. Hopefully that will at least take the edge off. But also hopefully that discomfort will help remind you next time to take extra steps to prevent sunburn.
Clothing which blocks or screens the harmful rays of the sun (UVA and UVB), in combination with wide-brimmed hats, sunglasses, and sunscreen, are all helpful in preventing damage to the eyes and skin. Any one of these by itself, even the sunscreen, may not be enough to prevent sun damage.
Malignant melanoma is the most dangerous type of skin cancer. Melanomas beneath the fingernail appear as a black or bluish black discoloration. This type of malignancy spreads (metastasizes) readily.
Increased risk for skin cancer, especially melanoma, is associated with chronic exposure to sunlight, blistering sunburns, and a family history of skin cancer.
Malignant melanoma is the most dangerous type of the skin cancers. Typical features of melanomas include irregular borders, multiple colors within the lesion, rapid growth, and susceptibility to easy injury with bleeding. Any mole that exhibits any of these changes should be evaluated immediately by your physician.
Malignant melanoma is the most dangerous type of the skin cancers. Typical features of melanomas include irregular borders, multiple colors within the lesion, rapid growth, and susceptibility to easy injury with bleeding. Any mole that exhibits any of these changes should be evaluated immediately by your physician.
Malignant melanoma is the most dangerous type of the skin cancers. Typical features of melanomas include irregular borders, multiple colors within the lesion, rapid growth, and susceptibility to easy injury with bleeding. Any mole that exhibits any of these changes should be evaluated immediately by your health care provider.
Sunburn results when the amount of exposure to the sun or other ultraviolet light source exceeds the ability of the body's protective pigment, melanin, to protect the skin. A serious sunburn is as serious as a thermal burn, and may have the same systemic effects such as blistering, edema and fever.
When the skin is overexposed to the ultraviolet rays of the sun a sunburn can occur. The symptoms of a sunburn can take up to 24 hours to appear. The skin can be red, warm, tender, blistered, and swollen.
Considerations
The first signs of a sunburn may not appear for a few hours. The full effect to your skin may not appear for 24 hours or longer. Possible symptoms include:
- Red, tender skin that is warm to the touch
- Blisters that develop hours to days later
- Severe reactions (sometimes called sun poisoning), including fever, chills, nausea, or rash
- Skin peeling on sunburned areas several days after the sunburn
Symptoms of sunburn are usually temporary. But the damage to skin cells is often permanent, which can have serious long-term effects. These include skin cancer and early aging of the skin. By the time the skin starts to become painful and red, the damage has been done. Pain is worst between 6 to 48 hours after sun exposure.
Causes
Sunburn results when the amount of exposure to the sun or other ultraviolet light source exceeds the ability of melanin to protect the skin. Melanin is the skin's protective coloring (pigment). Sunburn in a very light-skinned person may occur in less than 15 minutes of midday sun exposure, while a dark-skinned person may tolerate the same exposure for hours.
Keep in mind:
- There is no such thing as a "healthy tan." Unprotected sun exposure causes early aging of the skin and skin cancer.
- Sun exposure can cause first- and second-degree burns.
- Skin cancer usually appears in adulthood. But it is caused by sun exposure and sunburns that began as early as childhood.
Factors that make sunburn more likely:
- Infants and children are very sensitive to the burning effects of the sun.
- People with fair skin are more likely to get sunburn. But even dark and black skin can burn and should be protected.
- The sun's rays are strongest during the hours of 10 a.m. to 4 p.m. The sun's rays are also stronger at higher altitudes and lower latitudes (closer to the equator). Reflections off water, sand, or snow can make the sun's burning rays stronger.
- Sun lamps can cause severe sunburn.
- Some medicines (such as the antibiotics doxycycline and tetracycline) can make your skin easier to sunburn.
- Some medical conditions (such as lupus) can make you more sensitive to the sun.
Home Care
If you do get a sunburn:
- Take a cool shower or bath or place clean wet, cool wash cloths on the burn.
- DO NOT use products that contain benzocaine or lidocaine. These can cause allergies in some people and make the burn worse.
- If there are blisters, dry bandages may help prevent infection.
- If your skin is not blistering, moisturizing cream may be applied to relieve discomfort. DO NOT use butter, petroleum jelly (Vaseline), or other oil-based products. These can block pores so that heat and sweat cannot escape, which can lead to infection. DO NOT pick at or peel away the top part of the blisters.
- Creams with vitamins C and E may help limit damage to skin cells.
- Over-the-counter medicines, such as ibuprofen or acetaminophen, help to relieve pain from sunburn. DO NOT give aspirin to children.
- Cortisone creams may help reduce inflammation.
- Loose cotton clothing should be worn.
- Drink lots of water.
Ways to prevent sunburn include:
- Use a broad-spectrum sunscreen of SPF 30 or higher. A broad-spectrum sunscreen protects from both UVB and UVA rays.
- Apply a generous amount of sunscreen to fully cover exposed skin. Reapply sunscreen every 2 hours or as often as the label says.
- Reapply sunscreen after swimming or sweating and even when it is cloudy.
- Use a lip balm with sunscreen.
- Wear a hat with a wide brim and other protective clothing. Light-colored clothing reflects the sun most effectively.
- Stay out of the sun during hours when the sun's rays are strongest between 10 a.m. and 4 p.m.
- Wear sunglasses with UV protection.
We all know that preventing sunburn is the best. But what do you do if you get sunburn? I'm Dr. Alan Greene. Let's talk about that together. When you have a burn from the sun, a radiation burn from the sun, there are a couple of things going on. One is that there's a heat injury. The skin gets hot. You can feel it when you touch it. You can feel it in the burn itself. And another is the outer protective layer is damaged, so the skin can dry out too easily. So the keys to treating a sunburn are to keep the skin cool and moist. So, one great way to do that is with what we call a cool compress. Just take a washcloth. Put some cool water in there and press gently onto the skin. Or you might do a shower - frequent, cool, and lukewarm showers. Either way right afterwards you want to slather on a good moisturizer to try to seal some of that water in, moisture in, preferably a moisturizer that doesn't contain alcohol or any other drying agent. Another time-honored remedy is the Aloe vera plant. And there's some recent studies questioning how effective it really is, but many people swear by it. You cut a little tip off the end of the plant and that gel you rub just directly onto the sunburn itself. And it certainly feels soothing and may help beyond that. Another piece of treating sunburn is to deal with the pain and the inflammation. And for that you might try acetaminophen for the pain or ibuprofen for the pain and inflammation both. Hopefully that will at least take the edge off. But also hopefully that discomfort will help remind you next time to take extra steps to prevent sunburn.
When to Contact a Medical Professional
Call your health care provider right away if you have a fever with sunburn. Also call if there are signs of shock, heat exhaustion, dehydration, or other serious reactions. These signs include:
- Feeling faint or dizzy
- Rapid pulse or rapid breathing
- Extreme thirst, no urine output, or sunken eyes
- Pale, clammy, or cool skin
- Nausea, fever, chills, or rash
- Your eyes hurt and are sensitive to light
- Severe, painful blisters
What to Expect at Your Office Visit
Your provider will perform a physical exam and look at your skin. You may be asked about your medical history and current symptoms, including:
- When did the sunburn occur?
- How often do you get sunburn?
- Do you have blisters?
- How much of the body was sunburned?
- What medicines do you take?
- Do you use a sunblock or sunscreen? What type? How strong?
- What other symptoms do you have?
References
American Academy of Dermatology website. Sunscreen FAQs.
Dinulos JGH. Light-related diseases and disorders of pigmentation. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 19.
Sherman KS. Sunburn. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2023. Philadelphia, PA: Elsevier; 2023:1125-1126.
Version Info
Last reviewed on: 6/7/2023
Reviewed by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
