Sunburn

Overview

Sunburn is inflamed, painful skin that feels hot to the touch. It often appears within a few hours of being in the sun too long.

You can get sunburn relief with simple self-care measures such as taking pain relievers and cooling the skin. But it may take days for the sunburn to fade.

Preventing sunburn year-round by wearing sunscreen or using other skin-protection habits is important for everyone. It is especially important when you're outdoors, even on cool or cloudy days.

Symptoms

Sunburn symptoms can include:

• Inflamed skin, which looks pink or red on white skin and may be harder to see on brown or Black skin.
• Skin that feels warm or hot to the touch.
• Pain, tenderness and itching.
• Swelling.
• Small, fluid-filled blisters, which may break.
• Headache, fever, nausea and fatigue, if the sunburn is severe.
• Eyes that feel painful or gritty.

Any exposed part of the body — including the earlobes, scalp and lips — can burn. Even covered areas can burn if, for example, clothing has a loose weave that allows ultraviolet (UV) light through. The eyes, which are extremely sensitive to the sun's UV light, also can burn.

Sunburn symptoms often appear within a few hours after sun exposure.

Within a few days, the body may start to heal itself by peeling the damaged skin's top layer. A bad sunburn may take several days to heal. Any lingering changes in skin color usually go away with time.

When to see a doctor

See your health care provider if you:

• Develop large blisters.
• Develop blisters on the face, hands or genitals.
• Experience severe swelling of the affected area.
• Show signs of infection, such as blisters with pus or streaks.
• Experience worsening pain, headache, confusion, nausea, fever or chills.
• Get worse despite at-home care.
• Have eye pain or vision changes.

Seek immediate medical care if you are sunburned and experience:

• A fever over 103 F (39.4 C) with vomiting.
• Confusion.
• An infection.
• Dehydration.
• Cold skin, dizziness or faintness.

Causes

Sunburn is caused by too much exposure to ultraviolet (UV) light. UV light may be from the sun or artificial sources, such as sunlamps and tanning beds. UVA is the wavelength of light that can penetrate to the deep layers of skin and lead to skin damage over time. UVB is the wavelength of light that penetrates the skin more superficially and causes sunburn.

The UV light damages skin cells. The immune system reacts by increasing blood flow to the affected areas, which causes the inflamed skin (erythema) known as sunburn.

You can get sunburn on cool or cloudy days. Surfaces such as snow, sand and water can reflect UV rays and burn skin too.

Risk factors

Risk factors for sunburn include:

• Having white skin and red hair.
• Having a history of sunburn.
• Living or vacationing somewhere sunny, warm or at high altitude.
• Working outdoors.
• Swimming or spraying your skin with water or baby oil, as wet skin tends to burn more than does dry skin.
• Mixing outdoor recreation and drinking alcohol.
• Regularly exposing unprotected skin to UV light from sunlight or artificial sources, such as tanning beds.
• Taking a drug that makes you more likely to burn (photosensitizing medication).

Complications

Intense, repeated sun exposure that results in sunburn increases your risk of other skin damage and certain diseases. These include premature aging of skin (photoaging), precancerous skin lesions and skin cancer.

Premature aging of your skin

Sun exposure and repeated sunburns speed the skin's aging process. Skin changes caused by UV light are called photoaging. The results of photoaging include:

• Weakening of connective tissues, which reduces the skin's strength and elasticity.
• Deep wrinkles.
• Dry, rough skin.
• Fine red veins on the cheeks, nose and ears.
• Freckles, mostly on the face and shoulders.
• Dark or discolored spots (macules) on the face, back of hands, arms, chest and upper back — also called solar lentigines (len-TIJ-ih-neez).

Precancerous skin lesions

Precancerous skin lesions are rough, scaly patches in areas that have been damaged by the sun. They're often found on the sun-exposed areas of the head, face, neck and hands of people whose skin burns easily in the sun. These patches can evolve into skin cancer. They're also called actinic keratoses (ak-TIN-ik ker-uh-TOE-seez) and solar keratoses.

Skin cancer

Excessive sun exposure, even without sunburn, increases your risk of skin cancer, such as melanoma. It can damage the DNA of skin cells. Sunburns in childhood and adolescence may increase the risk of melanoma later in life.

Skin cancer develops mainly on areas of the body most exposed to sunlight, including the scalp, face, lips, ears, neck, chest, arms, hands, legs and back.

Some types of skin cancer appear as a small growth or a sore that bleeds easily, crusts over, heals and then reopens. With melanoma, an existing mole may change, or a new, suspicious-looking mole may grow.

See your health care provider if you notice:

• A new skin growth.
• A bothersome change in your skin.
• A change in the look or texture of a mole.
• A sore that doesn't heal.

Eye damage

Too much UV light damages the cornea. Sun damage to the lens can lead to clouding of the lens (cataracts). Sunburned eyes may feel painful or gritty. Sunburn of the cornea is also called snow blindness. This type of damage might be caused by the sun, welding, tanning lamps and broken mercury vapor lamps.

Prevention

Use these methods to prevent sunburn, even on cool, cloudy or hazy days. Sun exposure on cloudy days is decreased by about 20%. Be extra careful around water, snow, concrete and sand because they reflect the sun's rays. In addition, UV light is more intense at high altitudes.

• Avoid sun exposure between 10 a.m. and 4 p.m. The sun's rays are strongest during these hours, so try to schedule outdoor activities for other times. If you can't do that, limit the time you're in the sun. Seek shade when possible.
• Avoid sun tanning and tanning beds. Getting a base tan doesn't decrease your risk of sunburn. If you use a self-tanning product to look tan, also apply a sunscreen before going outdoors.

• Use sunscreen often and generously. Use water-resistant, broad-spectrum lip balm and sunscreen with an SPF of at least 30, even on cloudy days. Broad-spectrum products offer protection against ultraviolet A (UVA) and ultraviolet B (UVB) rays. SPF 30 blocks 97% of UVB rays. No sunscreen can block 100% of the sun's UVB rays.

  About 30 minutes before going outdoors, generously apply your sunscreen to clean, dry skin. Use at least 2 tablespoons of sunscreen, or 1 ounce, to cover all surfaces of the exposed skin, except the eyelids. If you're using spray sunscreen, spray it into your hands and then rub it into the skin. This helps avoid inhaling the product. Don't use a spray product while smoking or near an open flame.

  If you're using a product that contains physical blockers (titanium oxide, zinc oxide), apply it over any other products you're wearing — except insect repellent. Insect repellent goes on last. Physical blockers provide the most effective protection for sensitive skin.

  Reapply sunscreen every two hours — or more often if you're swimming or perspiring. If you're wearing makeup and want to reapply your sunscreen without redoing your whole face, one option is to use an SPF powder over makeup.

  The Food and Drug Administration (FDA) requires all sunscreen to retain its original strength for at least three years. Check sunscreen labels for directions on storing and expiration dates. Throw away sunscreen if it's expired or more than three years old.

• Protect babies and toddlers. Protect babies and toddlers from sunburn with brimmed hats and lightweight clothing that covers the arms and legs. Keep them cool, hydrated and out of direct sunlight. When that's not possible, the American Academy of Pediatrics suggests applying sunscreen with an SPF of at least 15 to the face and back of the hands. The American Academy of Dermatology and the FDA don't suggest sunscreen for children under 6 months.

  If sun-protective clothing and shade aren't available, sunscreens containing zinc oxide or titanium dioxide are the next best choice.

• Cover up. When outside, other items such as umbrellas or wide-brimmed hats can offer protection in addition to sunscreen. Dark clothing with a tight weave offers more protection. Consider using outdoor gear specially designed to provide sun protection. Check the label for its ultraviolet protection factor (UPF), which tells how well a fabric blocks sunlight. The higher the UPF number, the better.
• Wear sunglasses when outdoors. Choose sunglasses with UVA and UVB protection. Check the UV rating on the label when buying new glasses. Darker lenses don't always mean better UV protection. It also helps to wear sunglasses that fit close to your face or have wraparound frames.
• Be aware of sun-sensitizing medications and cosmetics. Some common prescription and nonprescription drugs can make skin more sensitive to sunlight. Examples include antibiotics, nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB, others) and cholesterol-lowering drugs. Talk with your pharmacist or health care provider about the side effects of drugs you take. Cosmetics that contain alpha-hydroxy acids also increase sun sensitivity.

Diagnosis

Diagnosing sunburn generally includes a physical exam. Your health care provider might also ask about your symptoms, current medications, UV exposure and sunburn history.

If you have sunburn or a skin reaction after only a short time in the sun, your health care provider might suggest phototesting. This is a test where small areas of skin are exposed to measured amounts of UVA and UVB light to mimic the problem. If your skin reacts to phototesting, you're considered sensitive to sunlight (photosensitive).

Treatment

Sunburn treatment doesn't heal your skin, but it can ease pain, swelling and discomfort. If care at home doesn't help or your sunburn is very severe, your health care provider might suggest a prescription corticosteroid cream.

For severe sunburn, your health care provider might admit you to a hospital.

Lifestyle and home remedies

Try these self-care tips for sunburn relief:

• Take a pain reliever. For pain relief, take a nonprescription pain reliever as soon as possible after getting too much sun. Examples include ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others). Or try a gel pain reliever that you rub on the skin.
• Cool the skin. Apply to the affected skin a clean towel dampened with cool tap water. Or take a cool bath with added baking soda — about 2 ounces (60 grams) a tub. Cool the skin for about 10 minutes several times a day.
• Apply a moisturizer, lotion or gel. An aloe vera lotion or gel or calamine lotion can be soothing. Try cooling the product in the refrigerator before applying. Avoid products made with alcohol.
• Drink extra water for a day. This helps prevent dehydration.
• Leave blisters alone. An intact blister can help the skin heal. If a blister does break, trim off the dead skin with a clean, small scissors. Gently clean the area with mild soap and water. Then apply an antibiotic ointment to the wound and cover it with a nonstick bandage.
• Treat peeling skin gently. Within a few days, the affected area may begin to peel. This is your body's way of getting rid of the top layer of damaged skin. While your skin is peeling, keep using moisturizer.
• Take an anti-itch drug. An oral antihistamine such as diphenhydramine (Benadryl, Chlor-Trimeton, others) might help relieve itching as the skin begins to peel and heal underneath.
• Apply a soothing medicated cream. For mild to moderate sunburn, apply nonprescription 1% hydrocortisone cream to the affected area three times a day for three days. Try cooling the product in the refrigerator before applying.
• Treat sunburned eyes. Apply a clean towel dampened with cool tap water. Don't wear contacts until your eye symptoms have gone away. Don't rub your eyes.
• Protect yourself from further sun exposure. While your sunburn heals, stay out of the sun or use other sun-protection measures. You might try a product that has moisturizers and sunscreen.

• Avoid applying '-caine' products, such as benzocaine. Such creams can irritate the skin or cause an allergic reaction. Benzocaine has been linked to a rare but potentially deadly condition that decreases the amount of oxygen that the blood can carry (methemoglobinemia).

Don't use benzocaine on children younger than age 2 without supervision from a health care provider. If you're an adult, never use more than the recommended dose and consider talking with your health care provider before using it.

Preparing for an appointment

Most sunburns heal fine on their own. Consider seeking treatment for severe or repeated sunburn. You're likely to first see your primary care provider. Before you go to your appointment, list the medications you're taking — including vitamins, herbs and nonprescription drugs. Some drugs increase your sensitivity to UV light.

Questions to ask your health care provider about sunburn include:

• Can I use nonprescription medications to treat the condition, or do I need a prescription?
• How soon after I begin treatment can I expect improvement?
• What skin care routines do you suggest while the sunburn heals?
• What suspicious changes in my skin might I watch for?

If your sunburn is severe or your health care provider notices unusual skin signs, you might be referred to a doctor who specializes in skin diseases (dermatologist).