SUNBURN

Sunburn occurs when your skin becomes red, painful, and damaged due to prolonged exposure to ultraviolet (UV) rays from the sun or tanning beds. Even with all the warnings about the dangers of sun exposure, many of us still find ourselves basking under its burning rays. Shockingly, over a third of adults and nearly 70% of children admit to getting sunburned within the past year, according to the CDC. But beyond the discomfort of a sunburn lies a more serious concern: the long-term effects of excessive sun exposure on our skin.

Over time, repeated exposure to the sun can lead to premature aging in the form of wrinkles and age spots, and it significantly increases the risk of developing skin cancer.

Types of Sunburn

Healthcare providers categorize sunburns based on the severity of skin damage:

First-degree sunburn: Involves damage to the outer layer of the skin, typically healing on its own within a few days to a week.
Second-degree sunburn: Affects the middle section of the skin (dermis) and often results in the formation of blisters on the affected area. Healing may take weeks, and medical treatment may be necessary. Third-degree sunburns are extremely rare and require immediate medical attention. They involve severe damage to all layers of the skin, including the underlying fat layer, and can even affect nerve endings. Most cases of third-degree burns result from chemical burns or exposure to fire, rather than sun exposure.

Causes of Sunburn

The process of sunburn seems simple enough: after spending too much time under the sun, the skin turns red and irritated. However, the science behind it is a bit more complex. The sun emits three types of ultraviolet (UV) light: UVA, UVB, and UVC. While UVC doesn’t reach the Earth’s surface, both UVA and UVB rays penetrate our skin, causing damage.

Visible sunburn is just the tip of the iceberg. Beneath the surface, UV light can damage our DNA, leading to premature aging and an increased risk of skin cancer, including the deadly melanoma.

Prevalence of Sunburn

Sunburns are prevalent, especially among young individuals. Statistics show that between 50% and 75% of children under the age of 18 experience sunburns annually. Furthermore, more than half of adults aged 18 to 29 reported experiencing one or more sunburns in 2015.

Stages of sunburn

Three Stages of Sunburn:

Although others may notice your skin turning pink under the sun’s rays, you might not realize you’re sunburned until the pain sets in. Typically, sunburn progresses through three distinct stages:

Initial Pain: Sunburn discomfort typically begins within a few hours of exposure to the sun.
Increased Redness and Irritation: As time passes, your skin becomes even redder and more irritated, reaching its peak discomfort around 24 hours after sunburn. If you have a second-degree sunburn, blisters may start to form during this stage.
Peeling and Healing: Over the following week or so, your sunburned skin may begin to peel as it undergoes the healing process. Gradually, your skin should return to its normal shade. For severe sunburns, this recovery process may take a few weeks.

Risk Factors Sunburn

Several factors can influence your likelihood of getting sunburned:

Duration of Sun Exposure: The longer you spend in the sun, the greater your risk of developing sunburn.
Medications: Certain medications, including antibiotics like doxycycline and Bactrim™, nonsteroidal anti-inflammatory drugs (NSAIDs), retinoids, and some heart medications, can increase skin sensitivity to UV rays, making sunburn more likely.
Intensity of UV Rays: Factors such as the time of day, cloud coverage, altitude, and proximity to the equator affect the intensity of UV radiation.
Ozone Depletion: The degree of ozone depletion in your region can influence the amount of UV radiation reaching the Earth’s surface.
Skin Type and Color: Individuals with fairer skin are generally more susceptible to sunburn, but people of all skin types can experience sunburn.
Tanning Beds: Use of tanning beds without proper sunscreen protection can also lead to sunburn.

Several factors can heighten your risk of experiencing sunburn:

Light Skin, Freckles, and Certain Features: Individuals with light skin tones, freckles, blue eyes, or red or blonde hair are more susceptible to sunburn.
Geographic Location: Living at high altitudes or closer to the equator increases exposure to intense UV radiation, thereby elevating the risk of sunburn.
Outdoor Activities: Engaging in outdoor sports, swimming, or spending prolonged periods on the water, such as boating, fishing, or paddleboarding, can heighten sunburn risk.
Tanning Practices: Regular tanning, whether through sun exposure or tanning beds, increases vulnerability to sunburn.
Occupational Exposure: Working outdoors exposes individuals to prolonged sunlight, increasing the likelihood of sunburn.

Sunburn Symptoms

When you experience sunburn, your skin can feel like it’s engulfed in flames—a sensation of intense heat and burning, exacerbated by even light touches, including clothing.

The symptoms of sunburn vary depending on the severity of the burn:

First-degree sunburn symptoms:

Redness, particularly noticeable on lighter skin tones (although sunburns can affect individuals with darker skin as well).
Sensation of heat or tightness in the skin.
Pain or tenderness in the affected area.
Swelling.
Peeling of the skin, usually occurring several days after the initial burn. Additional symptoms may include:
Fatigue.
Fever.
Headache.
Nausea.

Second-degree sunburn symptoms:

Intense redness of the skin.
Formation of blisters.
Swelling extending over a larger area.
Skin appearing wet.
Pain.
White discoloration within the burn. Symptoms of heat-related illnesses may also manifest, such as:
Confusion.
Dizziness.
Exhaustion.
Rapid breathing.
Fever.
Headache.
Muscle cramps.
Nausea.
Shivering.

Third-degree sunburn symptoms:

Skin takes on a leathery appearance.
Numbness in the affected area.
Skin appears white or dull. In severe cases, individuals may experience symptoms of shock and heat stroke, in addition to those of heat-related illnesses.

Appearance of Severe Sunburn

While no sunburn should be taken lightly, severe sunburns appear highly inflamed and deeply red. Blisters may develop, and the affected skin is likely to peel as it begins to heal.

Diagnosis of Sunburn

Healthcare providers diagnose sunburn by assessing the extent of skin damage, severity of symptoms, and affected areas. They may examine the burned skin and inquire about symptoms such as pain, redness, blistering, and other discomforts. Based on their evaluation, they can recommend appropriate treatment strategies to alleviate symptoms and promote healing.

It’s worth noting that while sunburns may be less visible on darker skin tones, they still cause damage, such as wrinkles and hyperpigmentation, and elevate the risk of skin cancer.

Finding Relief From Sunburn

Treating sunburn involves addressing both the inflammation and pain associated with the burn. Here are some effective home remedies:

Cold Compresses: Apply cold compresses to your skin or take a cool bath to soothe the burn.
Topical Creams or Gels: Rubbing a cream or gel containing ingredients like menthol, camphor, or aloe vera onto the affected area can alleviate discomfort. Aloe vera is particularly renowned for its anti-inflammatory properties, helping to soothe damaged skin and potentially prevent the burn from worsening. If you don’t have these specific ingredients, a moisturizing lotion without alcohol can also provide relief. For an extra cooling effect, refrigerate the cream or gel before use.
NSAIDs: Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can help reduce swelling and alleviate pain associated with sunburn.
Stay Hydrated: Drink plenty of water and other fluids to prevent dehydration, especially if you’re experiencing symptoms like dry mouth, thirst, reduced urination, dizziness, or fatigue.
Avoid Sun Exposure: Until your sunburn heals, it’s crucial to stay out of the sun to prevent further damage.

Duration and Long-Term Effects of Sunburn

The duration of sunburn symptoms varies depending on the severity of the burn. Typically, mild to moderate sunburns resolve within a few days to a week, while more severe cases may take longer to heal. However, despite the temporary discomfort, the damage to DNA in your skin cells caused by sunburn is permanent.

Long-term effects of frequent sunburns can include:

Premature skin aging, characterized by age spots, freckles, red veins, wrinkles, and loss of skin elasticity.
Development of precancerous skin lesions, which may manifest as scaly or rough patches on the skin.
Eye damage, increasing the risk of conditions such as cataracts.
Elevated risk of skin cancer, particularly in areas repeatedly exposed to the sun, such as the arms, back, ears, face, and legs. Skin cancers can present in various forms, including pink scaly spots, non-healing sores, or multi-colored lesions that may spread to internal organs.

Sunburn and Skin Cancer

When your skin is sunburned, it undergoes inflammation and swelling as your body’s immune cells rush to repair the damage. While some damaged skin cells may be repaired, others may accumulate DNA mutations that cannot be corrected. Over time, these effects contribute to skin aging and increase the risk of developing skin cancer.

When to Seek Medical Attention

While many sunburns can be treated at home, it’s essential to contact a doctor if you notice any of the following severe symptoms:

Fever of 102°F (38.9°C) or higher
Chills
Severe pain
Headache
Sunburn blisters covering 20% or more of your body
Signs of infection, such as pus seeping from blisters.
Symptoms of dehydration, such as dry mouth, thirst, reduced urination, dizziness, or fatigue

Additionally, if you observe any changes, growths, or bleeding in marks, bumps, blemishes, or moles on your skin, it’s crucial to consult your doctor promptly, as it may indicate skin cancer, which is more treatable when detected early.

Tips for Preventing Sunburn

Be mindful of the time: The sun’s rays are most potent between 10 a.m. and 4 p.m. If possible, try to avoid prolonged outdoor exposure during these peak hours. Opt for shady areas whenever you’re outdoors.
Dress appropriately: When venturing outside, choose clothing that provides sun protection, such as:
- A wide-brimmed hat to shield your face and neck
- Long-sleeved shirts and pants to cover exposed skin
- UV-blocking sunglasses to protect your eyes from harmful rays
Apply sunscreen: Cover any exposed skin generously with broad-spectrum sunscreen, which protects against both UVA and UVB rays. Look for a sunscreen with an SPF (sun protection factor) of at least 30. Here’s how to use sunscreen effectively:
- Apply sunscreen approximately 30 minutes before heading outdoors.
- Reapply every 90 minutes while outdoors, and more frequently after swimming or sweating.
- Even on cloudy days, apply sunscreen as UV rays can penetrate clouds.
- Reapply sunscreen every two hours, especially if sweating heavily or swimming.
- If you wear makeup, apply sunscreen first before applying foundation, as most foundations do not provide sufficient broad-spectrum protection.
Avoid Tanning: Refrain from suntanning and using tanning beds, which can intensify UV exposure and increase the risk of sunburn and skin damage.
Regular Skin Checks: Schedule annual skin cancer screenings with a dermatologist to monitor for any changes or abnormalities.
Please consult your doctor: It’s essential to discuss any medications you’re taking with your healthcare provider. Some antibiotics, antidepressants, and diabetes medications can increase skin sensitivity to the sun. Certain topical treatments, like Renova and Retin-A, can also heighten sunburn risk. If you’re using these medications, ask your doctor for advice on protecting your skin from sun exposure.

Sources

CDC: “Extreme Heat: A Prevention Guide to Your Personal Health and Safety.”
Journal of Investigative Dermatology: “Oral vitamin D rapidly attenuates inflammation from sunburn: an interventional study.”
Cancer Research UK: “Sunburn – Skin Cancer Prevention Advice.”
Johns Hopkins Medicine: “Sunburn in Children.”
American Academy of Dermatology: “Sunscreens,” “Be Sun Smart.”
Skin Cancer Foundation: “The Skin Cancer Foundation’s Guide to Sunscreens,” “Facts about Sunburn and Skin Cancer,” “Five Ways to Treat a Sunburn.”
Journal of the American Academy of Dermatology: “Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: Review from national surveys and case studies of 3 states.”
Auerbach, P. Wilderness Medicine, Mosby Elsevier, 2007.
Lucille Packard Children’s Hospital: “Facts About Sunburn.”
Winchester Hospital: “True or False: Dark-skinned People Don’t Need Sunscreen.”