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• Reactions to Sunlight
4

Sunburn is characterized by erythema and sometimes pain and blisters caused by exposure to solar ultraviolet radiation. Treatment is similar to that for thermal burns, including cool compresses, NSAIDs, and, for severe cases, sterile dressings and topical antimicrobials. Prevention by sun avoidance and use of sunscreens is crucial.

Sunburn results from overexposure of the skin to ultraviolet (UV) radiation; wavelengths in the UVB spectrum (280 to 320 nm) cause the most pronounced effects.

Symptoms and Signs

Symptoms and signs appear in 1 to 24 h and, except in severe reactions, peak within 72 h. Skin changes range from mild erythema, with subsequent superficial scaling, to pain, swelling, skin tenderness, and blisters.Constitutional symptoms (eg, fever, chills, weakness, shock), similar to a thermal burn, may develop if a large portion of the body surface is affected; these symptoms may be caused by the release of inflammatory cytokines such as IL-1.

Secondary infection, blotchy pigmentation, and miliaria-like eruptions are the most common late complications. Exfoliated skin may be extremely vulnerable to sunlight for several weeks.

Treatment

• Supportive measures

Further exposure should be avoided until sunburn has completely subsided. Cold tap water compresses and oral NSAIDs help relieve symptoms, as may topical aloe vera. Topical corticosteroids are no more effective than cool compresses. Blistered areas should be managed similarly to other partial-thickness burns (see Burns: Initial wound care), with sterile dressings and topical bacitracinSome Trade Names
AK-TRACIN
BACIGUENT
BACIIM
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or silver sulfadiazineSome Trade Names
SILVADENE
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. Ointments or lotions containing local anesthetics (eg, benzocaineSome Trade Names
AMERICAINE
ANBESOL
HURRICAINE
ORAJEL BABY TEETHING
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) should be avoided because of the risk of allergic contact dermatitis.

Early treatment of extensive, severe sunburn with a systemic corticosteroid (eg, prednisoneSome Trade Names
DELTASONE
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20 to 30 mg po bid for 4 days for adults or teenagers) may decrease the discomfort, but this use is controversial.

Prevention

Simple precautions (eg, avoiding the sun especially during midday, wearing tightly woven clothing, using sunscreens) ususally prevent most cases of sunburn (see Reactions to Sunlight: Prevention).

Last full review/revision August 2007 by Robert J. MacNeal, MD

Content last modified August 2007