Sunburn FAQs in Retail Clinics

Every day, the sun pounds the earth with radiation. Thankfully, we have some protection from the ultraviolet (UV) radiation that penetrates Earth’s atmosphere. Sunburn is still a major health issue that can be prevented.

WHAT IS A SUNBURN?

There are 3 types of UV radiation, and each one affects the body differently. UV-C is the most damaging, but it is filtered by the earth’s atmosphere and doesn’t reach us. UV-A accounts for about 95% of the UV radiation reaching the earth’s surface and is what leads to immediate tanning but also signs of aging skin such as spots, wrinkles, and sagging. UV-B, on the other hand, leads to delayed tanning, burning, and some aging and promotes the development of skin cancer.1 When these UV rays, particularly UV-B, hit our skin, they can cause a sunburn,¹which is our body’s inflammatory response to UV radiation. This response can range from mild to intense redness, pain, blistering, and peeling. The redness is usually first noticed 3 to 5 hours after sunlight exposure, peaks at 12 to 24 hours, and usually subsides after about 72 hours.²

WHO IS AT GREATER RISK OF GETTING A SUNBURN?

• People with lighter skin tones, blue or green eyes, and blond, red, or light brown hair.²
• Those who take medication.³There are countless medications that increase the risk of sunburn, so people should check with their health care providers or pharmacists before participating in activities with excessive sun exposure. Some commonly used medications that increase the risk of burning the antibiotics tetracyclines, fluoroquinolones, and sulfonamides; nonsteroidal anti-inflammatories such as ibuprofen, naproxen, ketoprofen, and celecoxib; diuretics such as furosemid, bumetanide, and hydrochlorothiazide; retinoids such as isotretinoin and acitretin; and hypoglycemics such as sulfonylureas (glipizide and glyburide).³
• Babies and children. These 2 groups should always be protected from the sun, but infants younger than 6 months should be kept out of direct sunlight altogether. Infant skin is especially delicate and prone to burning and is too sensitive for sunscreen. Additionally, babies are much more likely to suffer from heatstroke.⁴Dress them in lightweight clothing that covers their arms and legs and use a wide-brimmed hat, sunglasses, and a UV film or mesh cover for car windows that filters UV radiation.⁴After 6 months of age, they can also start wearing a broad-spectrum sunscreen with an SPF of 15 or greater that is gentle on their skin. A highly effective and very gentle key ingredient to look for is zinc oxide.
• People at higher altitudes. With every 1000 meters in altitude, UV levels increase by about 10%.^5,6
• Those close to the equator. The sun’s rays have a shorter distance to travel through the atmosphere, and therefore more of the harmful UV radiation can be absorbed.^5,6
• People near snow, sand, and water. All 3 reflect UV rays, increasing the risk of burning.²It is important to reapply sunscreen and use extra caution at the beach, when swimming, or when spending time in snowy areas.

HOW CAN PEOPLE MINIMIZE THEIR RISK OF BURNING?

Time of day:Avoid excessive sun exposure between 10 a.m. and 4 p.m.⁷Outdoor activities, especially during summer months, should be planned before or after these times as often as possible.

Sunscreen:Wear it every day. UV radiation can penetrate clouds and damage skin. SPF 15 blocks 93% of UV-B radiation, and SPF 30 blocks about 97%.⁸Apply sunscreen to all sun-exposed areas, such as the face, ears, nose, hands, toes, etc, 30 minutes before exposure, and reapply it every 1.5 hours to 2 hours,⁷even on cloudy days and after swimming or excessive sweating/moisture.

Recognize broad-spectrum ingredients:These include zinc oxide, avobenzone, titanium dioxide, salicylates, sulisobenzone, ecamsule, cinnamates, benzophenones, oxybenzone, merxoryl SX, and Parsol 1789.⁷

Clothes:Wear long pants and long-sleeved shirts made of tightly woven fabric. Wear sunglasses that provide 100% UV protection. Wear a wide-brimmed hat, and for maximum protection, consider clothing with a high ultraviolet protection factor.⁷

Medications:Both topical and oral medications can increase your skin’s susceptibility to burning.⁷Protect skin from the sun if you are using topical skin care products that contain alpha hydroxy acids.⁷These include glycolic, malic, tartaric, citric, and mandelic.

WHAT IS THE BEST WAY TO TREAT A SUNBURN?

For a mild to moderate sunburn, the goal is to control skin inflammation and pain. Use cool compresses and soaks, calamine lotion, or aloe vera—based gels.²Gentle emollients, such as liquid paraffin/white soft paraffin 50/50, can be used on intact skin.²Do not poke, pop, or attempt to rupture blister; keep them protected. Absolutely do not attempt to peel skin. Peeling and popping can lead to infection, bleeding, and scarring.

HOW LONG DOES A SUNBURN USUALLY LAST?

The redness usually goes away within 3 to 7 days, but blisters may not heal for 7 to 10 days.²

WHEN SHOULD PROFESSIONAL MEDICAL ATTENTION BE SOUGHT?

If a sunburn is not improving within a few days or if the pain and tenderness is increasing, swelling is forming, or signs of infection begin are forming, seek medical attention.²Signs of infection include an increase in pain, tenderness, swelling, fever, yellow or white drainage from a blister, and streaks leading away from cuts or blisters. Seek medical attention for severe symptoms such as nausea, vomiting, chills, fever, intense pain, confusion, weakness, fatigue, blistering, or burning over a large portion of the body.²

COMMON SUNSCREEN MYTHS

Wearing sunscreen leads to vitamin D deficiency:First, people need only about 10 to 15 minutes of sun exposure 2 to 3 times per week to produce needed vitamin D. Excessive sun exposure without wearing sun protection will not proportionally increase vitamin D absorption. If that were the case, people who get significant sun exposure would reach toxic levels of vitamin D9. There isn’t sufficient evidence to show that wearing sunscreen leads to vitamin D deficiency, but there is a plenty of research demonstrating the negative effects of excessive sun exposure, such as skin cancer and premature aging.⁹Bottom line: people should get vitamin D through a well-balanced, nutritious diet, and they should wear sunscreen outdoors.

Getting a base tan will protect me:A tan indicates that DNA damage has occurred, and that can lead to cancer. There is no such thing as a safe tan, and getting a base tan may provide protection equivalent to an SPF of only about 1.5 to 3.¹⁰Remember, the minimum effective SPF is 15.

Those who tan easily or who have darker skin do not need sun protection:Just as a base tan does not offer protection from the sun, having naturally darker skin does not give you permission not to use sunscreen. People with darker skin or who tan easily are still susceptible to skin cancer and premature aging. Latinos and those of Chinese and Japanese heritage tend to develop basal cell carcinoma, and African Americans and those of Indian heritage tend to develop squamous cell carcinoma.¹¹When the skin is exposed to UV radiation, it produces a pigment called melanin in response to the damage. This is what creates a tan, but it does not provide sufficient protection from damage.

Sara Marlow, MSN, RN, PHN, FNP-C

, is a licensed and board-certified family nurse practitioner, public health nurse, and adjunct assistant professor of health policy. She was the spring 2015 health policy fellow at the American Association of Nurse Practitioners’ government affairs office in Washington, DC, and is the co-chair of the Health Policy and Practice Committee of the California Association for Nurse Practitioners.

References

1. World Health Organization. UV radiation. World Health Organization website. http://who.int/uv/faq/whatisuv/en/index2.html. Accessed June 3, 2017.
2. Young A, Tewari A. Sunburn. UptoDate. http://www.uptodate.com/contents/sunburn. 2017. Accessed June 3, 2017.
3. Ngan V. Drug-induced photosensitivity. DermNet New Zealand website. http://dermnetnz.org/topics/drug-induced-photosensitivity/. Published 2006. Accessed June 3, 2017.
4. Skin Cancer Foundation. Sun safety tips for infants, babies and toddlers. Skin Cancer Foundation website. http://skincancer.org/prevention/sun-protection/children/sun-safety-tips-for-infants-babies-and-toddlers. Published July 6, 2009. Accessed June 3, 2017.
5. American Cancer Society. Are some people more likely to get skin damage from the sun? American Cancer Society website. http://cancer.org/cancer/skin-cancer/prevention-and-early-detection/sun-damage.html. Updated April 19, 2017. Accessed June 3, 2017.
6. World Health Organization. UV radiation. World Health Organization website. http://who.int/uv/faq/whatisuv/en/index3.html. Accessed June 3, 2017.
7. Food and Drug Administration. Sunscreen: How to help protect your skin from the sun. Food and Drug Administration website. http://fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm239463.htm. Updated July 14, 2017. Accessed August 11, 2017.
8. Skin Cancer Foundation. UVA & UVB. Skin Cancer Foundation website. http://skincancer.org/prevention/uva-and-uvb. Published May 24, 2013. Accessed June 3, 2017.
9. Skin Cancer Foundation. Sun protection and vitamin D. Skin Cancer Foundation website. http://skincancer.org/healthy-lifestyle/vitamin-d/damage. Published May 18, 2016. Accessed June 2, 2017.
10. Maron DF. Fact or fiction?: a “base tan” can protect against sunburn. Scientific American. http://scientificamerican.com/article/fact-or-fiction-a-base-tan-can-protect-against-sunburn/. Published May 22, 2015. Accessed June 3, 2017.
11. Perez M. Ask the expert: Can darker-skinned people get skin cancer? Skin Cancer Foundation website. http://skincancer.org/skin-cancer-information/ask-the-experts/can-darker-skinned-people-get-skin-cancer. Published 2009. Accessed June 3, 2017.