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Published on June 19, 2013

Sunburn

By Rob Broekemeier, FNP
Avera Medical Group Pierce

Hard to believe it has only been a few months since we were seeing snow, but thankfully, it is actually starting to feel like summer. Our children are out of school, which means more time outside enjoying those summer activities.  The sun is essential.  It can help our mental outlook and help us feel healthier. For people who have arthritis, the sun's warmth can help relieve some of their physical pain. Many people also think a suntan makes a person look young and healthy. But sunlight can be harmful to the skin, causing immediate problems, as well as problems that may develop years later.

Sunburn is skin damage from the sun's ultraviolet (UV) rays. Most sunburns cause mild pain and redness, but affect only the outer layer of skin (first-degree burn). The red skin might hurt when you touch it. These sunburns are mild and can usually be treated at home. Skin that is red, painful and swells up causing blisters may mean deep skin layers and nerve endings have been damaged (second-degree burn). This type of sunburn is usually more painful and takes longer to heal.

Other problems that can be present along with sunburn include heat stroke or other heat-related illnesses from too much sun exposure. Allergic reactions to sun exposure, sunscreen products, or  medicines can be a problem.  Also sun exposure can cause vision problems, such as burning pain, decreased vision, or partial or complete vision loss.

Long-term problems from sun exposure include: increased chance of having skin cancer; increase in the number of cold sores; increase in problems related to a health condition, such as lupus; increased chance of developing cataracts from lack of eye protection. Many years of direct and indirect sunlight is one of the leading causes of blindness. You can also have skin changes such as premature wrinkling or brown spots.
 
Your skin type affects how easily you become sunburned. People with fair or freckled skin, blond or red hair, and blue eyes usually sunburn easily. Your age also affects how your skin reacts to the sun. The skin of children younger than 6 and adults older than 60 is more sensitive to sunlight.  You may get more severe sunburns depending on a few factors.  You are more likely to get sunburn between 10:00 in the morning and 4:00 in the afternoon, when the sun's rays are the strongest. You might think the chance of getting sunburn on cloudy days is less, but the sun's damaging UV light can pass through clouds. You have an increased chance of sunburn when you are near reflective surfaces, such as water, white sand, concrete, snow, and ice. All of these reflect the sun's rays and can cause sunburns. The position of the sun on summer days can cause more severe sunburn.  It is easier to get sunburned at higher altitudes, because there is less of the earth's atmosphere to block the sunlight. UV exposure increases about 4% for every 1000 ft (305 m) gain in elevation.  It also depends on how close you are to the equator (latitude). The closer you are to the equator, the more direct sunlight passes through the atmosphere. For example, the southern United States gets 1.5 times more sunlight than the northern United States.  The UV index shows the risk of getting sunburn that day.

Preventive measures and home treatment are usually all that is needed to prevent or treat sunburn.

  • Protect your skin from the sun.
  • Do not stay in the sun too long.
  • Use sunscreens, and wear clothing that covers your skin.

If you have any health risks that may increase the seriousness of sun exposure, you should avoid being in the sun from 10:00 in the morning to 4:00 in the afternoon.

Home treatment measures that may provide some relief from mild sunburn are as follows:

  • Use cool cloths on sunburned areas.
  • Take frequent cool showers or baths.
  • Apply soothing lotions that contain aloe to sunburned areas. Topical steroids (such as 1% hydrocortisone cream) may also help with sunburn pain and swelling. Note: Do not use the cream on children younger than age 2 unless your health care provider tells you to do so. Does not use in the rectal or vaginal area in children younger than age 12 unless your health care provider tells you to do so.

Sunburn can cause mild fever and headache. Lie down in a cool, quiet room to relieve the headache. A headache may be caused by dehydration, so drinking fluids may help. For more information, see the topic Dehydration.There is little you can do to stop skin from peeling after sunburn—it is part of the healing process. Lotion may help relieve the itching.

Medicine you can buy without a prescription:

  • Acetaminophen, such as Tylenol
  • Nonsteroidal anti-inflammatory drugs (NSAIDs):
    • Ibuprofen, such as Advil or Motrin
    • Naproxen, such as Aleve or Naprosyn
    • Aspirin (also a nonsteroidal anti-inflammatory drug), such as Bayer or Bufferin

Be sure to follow these safety tips when you use a nonprescription medicine:

  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your health care provider before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your health care provider has told you to do so.
  • Talk to your child's health care provider before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

If you do get sunburn that causes blisters, there are a few things you can do on your own.  Small, unbroken blisters [less than 1 in. (2.5 cm) across] usually heal on their own. Do not try to break the blisters. Do not cover the blisters unless something such as clothing is rubbing against them. If you cover them, apply a loose bandage. Secure the bandage so the tape does not touch the blisters. Do not wrap tape completely around a hand, arm, foot, or leg, because it could cut off the blood supply if the limb swells. If the tape is too tight, you may develop symptoms below the level of the tape, such as numbness, tingling, pain, cool and pale skin or swollen skin. Avoid wearing clothes or shoes, or doing activities that rub or irritate the blisters until they have healed.  Large or broken blisters usually heal without problems. Most large blisters will break and heal on their own. Wash your hands with soap and water before touching blisters. Blisters can easily become infected. If you have a large blister, they may need to be drained, and we suggest you see your health care provider first before trying this on your own.  You can also use an antibiotic ointment sold OTC if you are not allergic to it. The ointment will prevent the bandage from sticking to the blister and may help prevent infection. Do not use alcohol or iodine on the blister, because these may delay healing. Do not use an ointment if you know you are allergic to it.

Watch for a skin infection while your blister is healing. Signs of infection include:

  • Increased pain, swelling, redness, or warmth around the blister.
  • Red streaks extending away from the blister.
  • Drainage of pus from the blister.
  • Fever.

Call your health care provider if any of the following symptoms occur during home treatment:

  • Vision problems continue after you get out of the sun.
  • Fever develops.
  • Dehydration develops and you are unable to drink enough to replace lost fluids.
  • Signs of skin infection in blisters develop.
  • Signs of an allergic reaction develop.
  • Symptoms become more severe or more frequent.

Protecting your skin is key!

Most skin cancer can be prevented. Use the following tips to protect your skin from the sun. You may decrease your chances of developing skin cancer and help prevent wrinkles.

Avoid sun exposure

The best way to prevent sunburn is to avoid sun exposure. Stay out of the midday sun (from 10:00 in the morning to 4:00 in the afternoon), which is the strongest sunlight. Find shade if you need to be outdoors. You can also calculate how much ultraviolet (UV) exposure you are getting by using the shadow rule: A shadow that is longer than you are means UV exposure is low; a shadow that is shorter than you are means the UV exposure is high.

Other ways to protect yourself from the sun include wearing protective clothing, such as:

  • Hats with wide 4 in. (10 cm) brims that cover your neck, ears, eyes, and scalp.
  • Sunglasses with UV ray protection, to prevent eye damage that may lead to cataracts.
  • Loose-fitting, tightly woven clothing that covers your arms and legs.
  • Clothing made with sun protective fabric. These clothes have a special label that tells you how effective they are in protecting your skin from ultraviolet rays.

Preventing sun exposure in children

You should start protecting your child from the sun when he or she is a baby. Because children spend a lot of time outdoors playing, they get most of their lifetime sun exposure in their first 18 years. It's safest to keep babies younger than 6 months out of the sun. If you can't keep your baby out of the sun, cover your child's skin with hats and clothing. Protect any bare skin with a small amount of sunscreen that is SPF 15 or higher.
Teach children the ABCs of how to protect their skin from getting sunburned:

A = Away. Stay away from the sun in the middle of the day (from 10:00 in the morning to 4:00 in the afternoon).
B = Block. Use a sunscreen with a sun protection factor (SPF) of 15 or higher to protect babies’ and children's very sensitive skin.
C = Cover up. Wear clothing that covers the skin, hats with wide brims, and sunglasses with UV protection. Even children 1 year old should wear sunglasses with UV protection.
S = Speak out. Teach others to protect their skin from sun damage.

Sunscreen protection

If you can't avoid being in the sun, use a sunscreen to help protect your skin. Be sure to read the information on the sunscreen label about the SPF factor listed on the label and how much protection it gives your skin. Follow the directions on the label for applying the sunscreen to provide the most effective protection for your skin from the sun's ultraviolet rays.

Choosing a sunscreen

Sunscreens come in lotions, gels, creams, ointments, and sprays. Use a sunscreen that:

  • Has a sun protection factor (SPF) of at least 15 or higher.
  • Says "broad-spectrum" that protects the skin from ultraviolet A and B (UVA and UVB) rays.

Use lip balm or cream that has SPF of 15 or higher to protect your lips from getting sunburned or developing cold sores .Use a higher SPF when you are near water, at higher elevations or in tropical climates. Sunscreen effectiveness is affected by the wind, humidity, and altitude. Some sunscreens say they are water-resistant or waterproof and can protect for about 40 minutes in the sun if a person is doing a water activity.
 
Applying a sunscreen

Apply the sunscreen at least 30 minutes before going in the sun. Apply sunscreen to all the skin that will be exposed to the sun, including the nose, ears, neck, scalp, and lips. Sunscreen needs to be applied evenly over the skin and in the amount recommended on the label. Most sunscreens are not completely effective because they are not applied correctly. It usually takes about 1 fl oz (30 mL) to cover an adult's body.
Apply sunscreen every 2 to 3 hours while in the sun and after swimming or sweating a lot. The SPF value decreases if a person sweats heavily or is in water, because water on the skin reduces the amount of protection the sunscreen provides. Wearing a T-shirt while swimming does not protect your skin from the sun, unless sunscreen has also been applied to your skin under the T-shirt.

Other sunscreen tips

The following tips about sunscreen will help you use it more effectively:

  • Older adults should always use a sunscreen with an SPF of at least 15 to protect their very sensitive skin.
  • If you have dry skin, use a cream or lotion sunscreen.
  • If you have oily skin or you work in dusty or sandy conditions, use a gel, which dries on the skin without leaving a film.
  • If your skin is sensitive to skin products or you have had a skin reaction (allergic reaction) to a sunscreen, use a sunscreen that is free of chemicals, para-aminobenzoic acid (PABA), preservatives, perfumes, and alcohol.
  • If you are going to have high exposure to the sun, consider using a physical sunscreen (sunblock), such as zinc oxide, which will stop all sunlight from reaching the skin.
  • If you need to use sunscreen and insect repellent with DEET, do not use a product that combines the two. You can apply sunscreen first and then apply the insect repellent with DEET, but the sunscreen needs to be reapplied every 2 hours.

Summer is a fun time to be had with family and friends.  Following these simple guidelines can make it more enjoyable and prevent future health issues.  If you have questions or concerns, please feel free to contact me or one of my colleagues at the Avera Medical Group in Pierce, and we will be happy to either see you or give you advice.  Be safe and have a happy, healthy summer.